Reminder: New standardized paper prior authorization form for prescription drugs, coming July 1

Last month, Blue Cross Blue Shield of Michigan announced that beginning July 1, 2016, we will use the new state of Michigan paper prior authorization form. It’ll help standardize the way doctors and insurers request and receive prior authorizations for prescription drug benefits.

Michigan Public Act 30 of 2013 amended the insurance code to require the creation of a single prior authorization form for use by health providers when a patient's health plan requires prior authorization for prescription drug benefits.

This law applies to Blue Cross commercial members only, not Medicare members or drugs provided under the medical benefit. Also, a different process will be used for Blue Care Network and Medicare Part D members.

Prescribers can submit an electronic preauthorization form online located on the Michigan Department of Insurance and Financial Services website: michigan.gov/difs**. Also, you can request the paper form by calling the Pharmacy Clinical Help Desk at 1-800-437-3803 or faxing it to 1-866-601-4425.

Electronic submission
Blue Cross includes electronic prior authorization forms on bcbsm.com/providers for commercial members. Submitting electronically offers many advantages, including the following:

• The ability to request prior authorizations 24 hours a day, seven days a week at your convenience.
• The convenience of starting a prior authorization, saving it if interrupted and then returning to it later without losing any entered data.
• The elimination of the need to wait on hold, make multiple calls or deal with multiple faxes relating to drug prior authorization requests.
• The ability of prescribers to look up the status of a drug prior authorization request.

New standardized paper submission
The new paper form doesn’t include all information that may be needed for a review or determination. However, the new law allows insurers to request additional information, including the following:

• Diagnosis
• Chart notes
• Lab information
• Genetic tests
• Information necessary for the approval of the prior authorization request under plan criteria
• Drug-specific information, including medication history, duration and treatment use

Blue Cross Pharmacy Services will soon be sending a short survey about prior authorization forms to prescribers. We greatly appreciate your response.

**Blue Cross Blue Shield of Michigan does not own or control the content of this website.