Quarterly update: Requirements changed for some commercial medical benefit drugs

Blue Cross Blue Shield of Michigan and Blue Care Network encourage proper utilization of high-cost medications that are covered under the medical benefit. As part of this effort, we maintain a comprehensive list of requirements for both Blue Cross and BCN commercial members.

During April, May and June 2020, the following medical drugs had authorization requirement updates, site-of-care updates or both for Blue Cross commercial (PPO only) members:

** Will become a unique code
***A unique code was assigned to this drug on July 1, 2020. Prior to July 1, this drug was assigned to a not-otherwise-classified, or NOC, code.

For a detailed list of requirements, see the Blue Cross and BCN utilization management medical drug list.

Additional notes
The authorization requirements apply only to groups that are currently participating in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. For PPO groups that don’t require members to participate in the programs, refer to the Specialty Pharmacy Prior Authorization Master Opt-in/out Group List. This list is available on the Blue Cross Drugs Covered Under the Medical Benefit page of the ereferrals.bcbsm.com website.

These changes don’t apply to Federal Employee Program^® Service Benefit Plan members.

An authorization approval isn’t a guarantee of payment. Health care providers need to verify eligibility and benefits for members.