HMO Drug Lists for Group Members

Who is this for?

Michigan Health Insurance – Customer Service – Pharmacy

If you have a HMO health plan that includes prescription drug coverage through an employer, you can use these drug lists to see if your plan covers a medication.

Employers with more than 50 full-time employees can choose the prescription drug coverage that goes with the health plans they provide. So not all group HMO plans from Blue Care Network share the same drug list.

To see if a medication is covered, you'll need to know whether your plan uses Preferred, Custom or Custom Select Drug List. You can find out by checking your prescription drug benefits by logging into the member portal. The portal will also allow you to find out what's covered, how much a medication will cost and compare brand-name prescriptions with generics. If you can't find your drug list here, call the customer service number on the back of your Blues ID card and we'll help.

Some additional resources can be used with most of our group HMO plans. They're listed below under "Other helpful resources."

Preferred drug lists

Preferred Drug List (PDF)
The list of drugs covered by your plan if your plan uses the Preferred Drug List. This drug list is updated monthly.

Preferred Drug List Prior Authorization and Step Therapy Guidelines (PDF)
A list of drugs that need to be approved before your plan will cover them.

Drug List Updates (PDF)
The latest additions and changes to Blue Cross Blue Shield and BCN's drug lists.

Preferred Drug List Exclusions (PDF)
A list of drugs that aren’t covered on the Preferred Drug List. Use this list to find alternatives for drugs that aren’t covered. 

Quantity Limit Program (PDF)
A list of drugs that have limits on the amount of medication you can fill.

Custom drug lists

Custom Drug List (PDF)
The list of drugs covered by your plan if your plan uses the Custom Drug List. This drug list is updated monthly.

Prior Authorization and Step Therapy Guidelines (PDF)
A list of drugs that need to be approved before your plan will cover them.

Drug List Updates (PDF)
The latest additions and changes to Blue Cross Blue Shield and BCN’s drug lists.

Preferred Alternatives (PDF)
If your plan uses the Custom Drug List and a drug you've been prescribed is a non-preferred drug, your doctor can use this list to find an alternative.

Custom Drug List Exclusions (PDF)
A list of drugs that aren't covered on the Custom Drug List. Use this list to find alternatives for drugs that aren’t covered. 

Quantity Limits Program for HMO Custom and Custom Select Drug Lists (PDF)
A list of drugs that have limits on the amount of medication you can fill.

Custom Select drug lists

Custom Select Drug List (PDF)
The list of drugs covered by your plan if your plan uses the Custom Select Drug List. This drug list is updated monthly.

Prior Authorization and Step Therapy Guidelines (PDF)
A list of drugs that need to be approved before your plan will cover them.

Drug List Updates (PDF)
The latest additions and changes to Blue Cross Blue Shield and BCN’s drug lists.

Custom Select Drug List Exclusions (PDF)
A list of drugs that aren't covered on the Custom Select Drug List. Use this list to find alternatives for drugs that aren’t covered. 

Quantity Limits Program for HMO Custom and Custom Select Drug Lists (PDF) 
A list of drugs that have limits on the amount of medication you can fill.

Other helpful resources

Preventive Drug List for Members with Health Savings Accounts-Including Diabetic Drugs (PDF)
A list of preventive drugs that help you lose weight, lower your cholesterol, lower your blood pressure, manage your blood sugar and other drugs that address other common conditions.

Preventive Drug Coverage (PDF)
A list of preventive drugs that are covered with $0 copay. For information specific to your preventive benefits, please check your Blue Cross benefits-at-a-glance or BCN drug rider.

Preventive Drug List for Members with Health Savings Accounts (PDF)
A list of preventive drugs that help you lose weight, lower your cholesterol, lower your blood pressure and other drugs that address other common conditions.

Specialty Drug Program Member Guide (PDF)
A list of drugs used to treat complex and chronic illnesses that require special handling. Use this guide to find out more information on your plan’s requirements for filling specialty drugs, to look up your drug, and to find out where and how to fill your prescription.

15-Day Specialty Drug Limitation Program (PDF)
A list of specialty drugs that have a 15-day supply limit.

Exclusive Smart90SM Maintenance Drug List (PDF)
A list of prescription drugs that you get at a participating Smart90 retail pharmacy or through Express Scripts mail-order in order for them to be covered by your plan, after your first two fills of the prescription.