How Do I Ask My Plan to Cover a Prescription Drug or Contraceptive?

In most cases, your health insurance plan only covers or helps pay for prescription drugs (including some contraceptives) that are included on the plan’s prescription drug list.

Select contraceptives may be covered, with no out-of-pocket costs, under our preventive drug coverage (PDF). To see if your prescription drug plan will cover a prescription drug or contraceptive, view our drug lists.

Depending on what type of health plan you have, we may need to review and approve some of your medications before we cover them. We call this prior authorization. We want to know if the medication is medically necessary and appropriate for your situation. If you don’t get prior authorization, a medication may cost you more, or we may not cover it.

What if your doctor prescribes a drug or contraceptive not on these drug lists? Or you or your doctor feel an exception should be made to requirements for a drug or contraceptive?

Requesting a review

Usually, your doctor works with our pharmacy experts to find the safest, most effective and reasonably priced drug or contraceptive that your health plan will cover or help pay for.

You can also contact us online and ask us to review a prescription:

  • Blue Cross Blue Shield of Michigan PPO members and Blue Care Network HMO members should use this Coverage Request Form. After we receive it, we'll contact your doctor about the prescription, or we'll contact you for more information.

When you can expect a response after our review

When it's an urgent request because of a life-threatening condition or situation, we make our decision within 24-72 hours.

In all other cases, we make our decision within 15 days.

Next steps

If your health plan won't cover or help pay for a drug after a review, you can file an appeal. Just follow these instructions. We'll need to know if you’re a Blue Cross Blue Shield of Michigan PPO member or a Blue Care Network HMO member. 

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