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July 2019

Blue Cross expanding medical benefit prior authorization program for commercial members starting Aug. 1

Beginning Aug. 1, 2019, the Magna International, Magna Mirrors and Michigan Electrical groups will be added to the Medical Drug Prior Authorization Program for Blue Cross Blue Shield of Michigan PPO commercial members. This change applies to members starting therapy on or after Aug. 1.

The authorization requirement only applies to groups that are currently participating in the commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. To find a list of groups that don’t take part in the program, follow these steps:

  1. Log in to Provider Secured Services.
  2. Click on BCBSM Provider Publications and Resources.
  3. Click on Newsletters & Resources.
  4. Click on Forms.
  5. Click on Physician administered medications.
  6. Click on BCBSM Medical Drug Prior Authorization Program list of groups that have opted out.

BCN AdvantageSM, Blue Cross Medicare Plus BlueSM PPO and Federal Employee Program® members don’t take part in the Medical Drug Prior Authorization Program.

Keep in mind that a prior authorization approval isn’t a guarantee of payment. Health care providers need to verify eligibility and benefits for members. Members are responsible for the full cost of medications not covered under their medical benefit coverage.

For a list of requirements for drugs covered under the medical benefit, click here.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.
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