|
September 2017
Help prevent denials on prior authorizations for weight loss, diabetes and testosterone drugs
Blue Cross Blue Shield of Michigan understands that submitting prior authorization forms takes time, and we want to help improve the process by working more closely with our health care providers. As we work toward a more efficient prior authorization process, we’ve identified three medication classes that are often missing key lab values and patient-specific data that are required for coverage.
Medications that are most commonly denied due to missing patient data on drug request forms include weight loss drugs and testosterone.
Remember to submit the required lab values or measurements for the following:
Drug category |
Required lab values or measurements |
Weight loss
(e.g., Saxenda®, Contrave®, Belviq®, Qsymia®) |
Current weight (within 30 days) and body mass index
Also required: Documentation of lifestyle modifications |
Testosterone
(e.g., Androgel®, Axiron®, Fortesta®, Testim®) |
Two morning testosterone levels in the past year included in the lab report
Also required: At least two documented signs or symptoms of testosterone deficiency |
Note: The table above doesn’t include all requirements for drug coverage. For a complete list of criteria, see the BCBSM Prior Authorization and Step Therapy guidelines.
Blue Cross-specific prior authorization forms, sorted by drug, can be submitted online through a web-based system. Use the Provider Secured Services electronic prior authorization portal to ensure your patients receive treatment in a timely manner.
|
