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 the fourth quarter of 2020, there were changes to prior authorization requirements, site-of-care requirements or both for Blue Cross commercial members for the following medical benefit drugs:

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 at ereferrals.bcbsm.com.

These authorization requirements apply only to groups that currently participate 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 participate in the program, see the Specialty Pharmacy Prior Authorization Master Opt-in/out Group List.

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