Specialty drug to be added to Medical Drug Prior Authorization program June 1

Beginning June 1, 2016, an additional specialty drug will require prior authorization by Blue Cross Blue Shield of Michigan before it’s covered under a member’s medical benefits.

Prior authorization is just a clinical review approval, not a guarantee of payment. Providers will need to verify the necessary coverage for this medical benefit.

Starting June 1, 2016, the following drug will need prior authorization:

You can find medication request forms, within the list of medications that require prior authorization, on web-DENIS:

• Click on BCBSM Provider Publications and Resources.
• Click on Commercial Pharmacy Prior Authorization and Step Therapy forms.
• Click on Physician administered medications (on the right side under Frequently Used Forms).

We won’t consider a request for coverage until we receive a physician-signed medication request form faxed or mailed to Blue Cross, or a request uploaded onto NovoLogix, an online-based tool. Standard processing time for request review is 15 days. An urgent request can be reviewed within 72 hours.

The list below reflects all the medications that are part of the Medical Drug Prior Authorization program.

Blue Cross reserves the right to change this list at any time.

Note: The prior authorization requirement doesn’t apply to Medicare, Medicare Advantage or Federal Employee Program^® members.