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 covered under the medical benefit. One way we do this is by maintaining a comprehensive list of requirements for both Blue Cross and BCN commercial members.

During July, August and September 2020, the following medical drugs had authorization requirement updates, site-of-care updates or both for Blue Cross commercial members:

For a detailed list of requirements, see the Blue Cross and BCN utilization management medical drug list. This list is available on the Blue Cross Medical Benefit Drugs page of the ereferrals.bcbsm.com website.

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

These changes don’t apply to Blue Cross and Blue Shield Federal Employee Program^® members.

As a reminder, an authorization approval isn’t a guarantee of payment. Health care providers need to verify eligibility and benefits for our members.