Commercial Medical Drug Prior Authorization Program adds a specialty drug

Starting Dec. 1, 2017, one additional specialty drug, as follows, will require prior authorization by Blue Cross Blue Shield of Michigan before it will be covered under a member’s medical benefits.

Keep in mind that prior authorization is a clinical review approval only, not a guarantee of payment.

You can find prior authorization forms for all physician-administered medications on web-DENIS. When logged in, follow these steps:

• Click on BCBSM Provider Publications and Resources.
• Click on Commercial Pharmacy Prior Authorization and Step Therapy forms.
• Click on Go to the Forms page.
• Click on Physician administered medications.

We won’t consider requests for coverage until we receive one of the following:

• Physician-signed medication request form by fax or mail
• Request uploaded to NovoLogix

Our standard processing time to review requests is 15 days. We’ll review urgent requests within 72 hours.

Here are all the medications that are currently part of the Commercial Medical Drug Prior Authorization Program list:

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

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