What's Prescription Drug Prior Authorization?

Prescription drug prior authorization is how Blue Cross Blue Shield of Michigan reviews certain medications before they're covered. The process ensures you're getting the right medication for the right situation.

Why would a drug need prior authorization?

We may request prior authorization because a drug:

  • Has serious adverse effects
  • Can be harmful when combined with other drugs
  • Should be used only for certain health conditions
  • Has a history of misuse or abuse
  • Has less expensive alternatives
  • May be covered by Medicare Part B or Part D

What if my prescription requires prior authorization?

You or your pharmacist should talk to your doctor. There may be another drug you can take that doesn't need prior authorization. If not, you can start the approval process by calling the number on the back of your Blue Cross ID card.

You can also start the approval process by filling out our online coverage determination form.

How do I know if a drug needs prior authorization?

You can learn how to read a drug list, but generally your pharmacist will tell you if a drug requires prior authorization.

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Related forms and documents

Request for Medicare Prescription Drug Coverage Determination (PDF)
Send us this completed form to request we make an exception for your drug.
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