Improved commercial utilization management medical drug list now available

We’ve published updated documents with utilization management information about drugs covered under the medical benefit for Blue Cross Blue Shield of Michigan and Blue Care Network members. We’ve made changes to the documents, based on feedback from providers and others, to make the information more accessible, clear and streamlined.

The redesigned Blue Cross and BCN utilization management medical drug list:

• Offers a fuller explanation of our medical drug utilization management programs for commercial members
• Indicates more clearly where to submit prior authorization requests — to AIM Specialty Health^® or through the NovoLogix^® online tool
• Specifies which drugs have prior authorization and site-of-care requirements
• Shows the preferred and nonpreferred products for drugs that we’ve designated as preferred products
• No longer contains medical policy information or documentation requirements information, which makes the list shorter and easier to use

The quantity limits information is in a separate document titled Blue Cross and BCN quantity limits for medical drugs. Here are highlights:

• It provides easier access for providers who need only the quantity limits.
• It indicates whether the quantity limits apply to in-state or out-of-state providers or both.
• The Blue Cross and BCN utilization management medical drug list includes a link to the Blue Cross and BCN quantity limits for medical drugs document in the introductory text and in the table heading on each page.

We make these lists available at ereferrals.bcbsm.com:

• On the Blue Cross Medical Benefit Drugs page
• On the BCN Medical Benefit Drugs page

You’ll also be able to find these lists behind the provider portal.

We appreciate the feedback we received from the provider community, and welcome additional comments on the new documents. Blue Cross and BCN are committed to providing reliable, up-to-date, easy-to-use resources to help you navigate the medical-benefit drug utilization management programs we have in place.