To help make sure Blue Cross Blue Shield of Michigan and Blue Care Network members receive the most appropriate and cost-effective therapy, we require providers to take additional steps before certain drugs are eligible for reimbursement. 

Prior authorization requirements

We require providers to request prior authorization for certain medicines, such as specialty drugs, to ensure certain clinical criteria are met.

Submitting prior authorization requests

For drugs that require prior authorization, providers should submit requests as follows:

For commercial members: 

• For most pharmacy benefit drugs and medical benefit drugs, including gene and cellular therapies, submit requests through the Medical and Pharmacy Drug PA Portal. To submit requests, select the Medical/Pharm Drug Benefit Auth (Commercial) tile on the provider portal. 
• Learn about submitting requests electronically and through other methods on Blue Cross Pharmacy Benefit Drugs or on BCN Pharmacy Benefit Drugs. You can also submit requests through CoverMyMeds. 

For Medicare Advantage members: 

• For most pharmacy benefit drugs, submit requests through CoverMyMeds. Learn about submitting requests electronically and through other methods on Blue Cross Pharmacy Benefit Drugs or on BCN Pharmacy Benefit Drugs. 
• For most medical benefit drugs, including gene and cellular therapy drugs, submit requests through NovoLogix^®. Learn about submitting requests through NovoLogix and through other methods on Blue Cross Pharmacy Benefit Drugs or on BCN Pharmacy Benefit Drugs. 

For members with requirements under the Oncology Value Management program: 

• For Blue Cross commercial UAW Retiree Medical Benefits Trust members, submit prior authorization requests for oncology and supportive care drugs covered under the medical benefit to Carelon Medical Benefits Management. Learn about submitting requests on Blue Cross Medical Benefit Drugs.
• For all other members, submit prior authorization requests for oncology and supportive care drugs covered under the medical benefit or under the pharmacy benefit, to OncoHealth. Learn about submitting requests to OncoHealth on Blue Cross Medical Benefit Drugs, BCN Medical Benefit Drugs, Blue Cross Pharmacy Benefit Drugs or on BCN Medical Benefit Drugs.

Step therapy requirements

Step therapy requires that the member has tried an alternative therapy first, or that the prescriber has clinically documented why the member cannot take the alternative therapy. In some cases, step therapy requirements may require members to first try over-the-counter products.