Michigan BAC and MPSERS members to participate in Medical Drug Prior Authorization Program

Beginning Jan. 1, 2017, members of the Michigan Bricklayers and Allied Crafts Health Care Fund, or Michigan BAC, and the Michigan Public School Employees Retirement System, or MPSERS, will participate in the Medical Drug Prior Authorization Program.

This program does not apply to Medicare, Medicare Advantage or Federal Employee Program^® members.

The chart below lists the medications that are part of the Medical Drug Prior Authorization Program.

Drug names

Actemra^®	Depo^®-Testosterone	Kalbitor^®	Signifor^® LAR
Acthar^® gel	Dysport^®	Kanuma™	Simponi Aria^®
Adagen^®	Elaprase^®	Krystexxa^®	Soliris^®
Aldurazyme^®	Elelyso™	Lemtrada™	Stelara^®
Aralast NP™	Entyvio™	Lumizyme^®	Stelara IV^®
Aveed^®	Fabrazyme^®	Makena^®	Synagis^®
Benlysta^®	Firazyr^®	Myobloc^®	Testopel^®
Berinert^®	Flebogamma^® DIF	Myozyme^®	Tysabri^®
Bivigam™	Gammagard Liquid^®	Naglazyme^®	Vimizim™
Botox^®	Gammagard^® S/D	Nplate^®	Vpriv^®
Carimune^® NF	Gammaked^®	Nucala^®	Xeomin^®
Cerezyme^®	Gammaplex^®	Octagam^®	Xgeva^®
Cimzia^®	Gamunex^®	Orencia^®	Xiaflex^®
Cinqair^®	Glassia™	Privigen^®	Xolair^®
Cinryze^®	Hizentra^®	Probuphine^®	Zemaira^®
Cosentyx™	HyQvia^®	Prolastin^®-C
Cuvitru^®	Ilaris^®	Prolia^®
Delatestryl^®	Immune globulin	Ruconest^®

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2015 American Medical Association. All rights reserved.