For Providers: How Do I Request a Prescription Drug Prior Authorization?

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

Prior authorization

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

Submitting a request electronically

Providers can request prior authorization electronically for:

• Most medical benefit drugs, including CAR T-cell therapy drugs, through NovoLogix^® by logging in to the secured provider portal
• Oncology and supportive care drugs through AIM Specialty Health^®

You can find how to submit a request, details on specific drug requirements and additional resources on these pages:

• Medical benefit drugs for Blue Cross and Medicare Plus Blue^SM 
• Medical benefit drugs for BCN and BCN Advantage^SM

Other ways to submit a request

• Calling 1-800-437-3803
  
• Faxing BCBSM at 1-866-601-4425
• Faxing BCN at 1-877-442-3778
• Writing: 
  Blue Cross Blue Shield of Michigan, Pharmacy Services
  Mail Code 512
  Detroit, MI 48226-2998

Step therapy

Step therapy requires that the member has tried an alternative therapy first, or that their physician has clinically documented why they cannot take the alternative therapy. Step therapy may include select over-the-counter products.