Blue Cross adding 2 additional specialty drugs to Medical Drug Prior Authorization program Oct. 1

Beginning Oct. 1, 2016, two more specialty drugs will need prior authorization from Blue Cross Blue Shield of Michigan before they’ll be covered under a member's medical benefits.

Keep in mind that prior authorization is just a clinical review approval, not a guarantee of payment. Providers will still need to verify the necessary coverage for this medical benefit. Our office will accept the medical drug prior authorization request forms, with supporting documentation, for these newly added drugs as early as Aug. 1, 2016.

Starting Oct. 1, 2016, the following two drugs will need prior authorization:

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

1. Click on BCBSM Provider Publications and Resources.
2. Click on Commercial Pharmacy Prior Authorization and Step Therapy forms.
3. 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 shows all the medications that are part of the Medical Drug Prior Authorization Program.

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

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