Pharmacy Programs

These programs help our members pay less out-of-pocket on prescription drugs. They save money while continuing to receive the effective, high-quality medical care they count on.

Preferred therapy

This program encourages the use of the most cost effective drugs over the higher priced brand-name medications if a prescription for the targeted brand-name medication has not been filled in the last six months (180 days).

Program requirements are listed in the BCBSM Prior Authorization/Step Therapy Guidelines (PDF).

Off-Label / High-Cost Specialty Review Program

This program disallows coverage for drugs prescribed for uses other than those approved by the FDA and requires a prior authorization review of other high cost specialty drugs.

Program requirements are listed in the BCBSM Prior Authorization/Step Therapy Guidelines (PDF).

Quantity limit for selected drugs

We'll block the dispensing of targeted drugs in quantities that are inconsistent with their labeling.

  • Quantity Limit Program (PDF): Use this chart for all Blue Cross Blue Shield of Michigan plans that include quantity limits. It lists our 30- and 90-day quantity limits for medications.

Questions? We can help!

To verify a member's benefit plan or get answers to your pharmacy-related questions, please contact us.