List features drugs not covered on the commercial Blue Cross drug list and preferred alternatives

To address the high cost of drugs and provide the best value for our members, Blue Cross Blue Shield of Michigan commercial plans will not cover select high-cost, FDA-approved drugs for which more cost-effective therapeutic alternatives are available. The drugs listed below are not covered on the commercial Blue Cross drug lists. In most cases, if a member fills a prescription for one of these drugs, he or she will pay the full retail price.

Providers should write a prescription for one of the preferred alternatives that Blue Cross covers. They have similar effectiveness, quality and safety but at a fraction of the cost. Our exclusions criteria are based on current medical information and have been approved by the Blue Cross Pharmacy and Therapeutics Committee. If medical necessity coverage is approved, quantity limits may apply.

This list is not comprehensive. As part of this ongoing initiative, Blue Cross will continue to identify select high-cost drugs and will stop covering them when there are more cost-effective alternatives available for our commercial members.

Note: Michigan Education Special Services Association members are excluded from this program.

The list will be continuously updated and can be found online at the following locations:

• PPO drug lists for group members
• Clinical drug list
• Custom drug list
• Pharmacy Services
• 2016 drug lists

Drug list exclusions for Blue Cross commercial plans
The drugs shown below aren’t covered on the commercial Blue Cross Blue Shield of Michigan drug lists. In most cases, if you fill a prescription for one of these drugs, you’ll pay the full retail price.

Drug list exclusions at a glance
Click on each of the following excluded drugs for more information.:

Drug list exclusions with preferred alternatives
This list contains the class, subclass and preferred alternatives for the excluded drug. The trade names for the preferred alternatives are listed in parenthesis for reference.

Note: These exclusions apply to most Blue Cross commercial members; they don’t apply to Medicare Advantage plans.