Prior Authorization/Step Therapy Program

To help make sure our members receive the most appropriate and cost-effective therapy, some benefit plans require that additional steps be taken before certain drugs are covered. One or both of these steps may be required, depending on the drug:

  • Prior Authorization: Certain clinical criteria must be met before some drugs are covered. 
  • 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. 

Which drugs require prior authorization or step therapy?

Drugs that require prior authorization or step therapy differ based on the drug list the member's plan uses:

How to request approval

Physicians can request approval one of four ways:

  • Online: Log in as a provider on, then select "Pharmacy Benefit - Medication Prior Authorization"
  • Call: 1-800-437-3803
  • Fax: 1-866-601-4425
  • Write: Blue Cross Blue Shield of Michigan, Pharmacy Services, P.O. Box 2320, Detroit, MI 48231-2320

Questions? We can help!

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

©1996-2016 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. We provide health insurance in Michigan.

State and Federal Privacy laws prohibit unauthorized access to Member's private information. Individuals attempting unauthorized access will be prosecuted.

Site Map  |  Feedback  |  Important Legal and Privacy Information

BCBSM is an Accredited Business through the Better Business Bureau