PPO Drug Lists for Group Members

Who is this for?

Michigan Health Insurance – Customer Service – Pharmacy

If you have a PPO 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 PPO plans from Blue Cross Blue Shield of Michigan share the same drug list.

To see if a medication is covered, you'll need to know whether your plan uses Preferred, Clinical, Custom or Custom Select drug lists. You can find out by checking your prescription drug benefits by logging into the member portal. Additionally, 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 lists can be used with most of our group PPO plans. They're listed below under "Other helpful drug lists."

Preferred drug lists

Preferred Drug List (PDF)

Preferred Drug List Authorization and Step Therapy Guidelines (PDF) 

Drug List Updates (PDF)

Preferred Drug List Exclusions (PDF): A list of drugs that aren't covered on the commercial Blue Cross and BCN Preferred Drug List. 

Clinical drug lists

Use with a flat dollar or two-tier plan only.

A flat dollar plan has one fixed copay for all covered drugs.

A two tier plan has two fixed copays, one for generic drugs and one for brand name drugs. 

Custom drug lists

Custom Select drug lists

Other helpful drug lists

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.

Drug List Exclusions (PDF): A list of drugs that aren't covered on the commercial Blue Cross Blue Shield of Michigan drug lists. 

Preventive Drug Coverage (PDF): A list of preventive drugs that are covered with $0 copay.

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. 

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

Quantity Limit Program Drug List (PDF): A list of drugs that have 30- and 90-day quantity limits.

Specialty Drug Program Member Guide (PDF): A list of drugs used to treat complex and chronic illnesses that require special handling. The guide also includes the enrollment form for ordering specialty drugs from Walgreen's Specialty Pharmacy.

15-Day Specialty Drug Limitation Program List (PDF): A list of potent 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.