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.
We require providers to request prior authorization for certain medicines, such as specialty drugs, to ensure certain clinical criteria are met.
For drugs that require prior authorization, providers should submit requests as follows:
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.