For Providers: Drug Lists

Use these documents to find drug coverage information, as well as prior authorization or step therapy requirements, for your Blue Cross Blue Shield of Michigan, Blue Care Network and Medicare Advantage patients.

 

Non-Medicare plans

Clinical Drug Lists

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Clinical Drug List

Refer to this list for drug coverage information for Blue Cross members whose plan uses the Clinical Drug List. This drug list is updated monthly.

PDF

Clinical Drug List Updates

This document includes recent changes that may not yet be reflected on our drug lists.

PDF

Preferred Alternatives for Nonpreferred and Nonformulary (Not Covered) Drugs – Clinical Drug List

Refer to this list for suggested covered preferred alternatives for nonpreferred and nonformulary drugs that can be dispensed with lower out-of-pocket costs for members.

PDF

Prior Authorization and Step Therapy Guidelines for Clinical Drug List

This document explains coverage criteria for drugs on the Clinical Drug List.

PDF

Quantity Limit Program Drug List

This document spells out our quantity limits for certain drugs, like opioids.

Custom Drug Lists

PDF

Custom Drug List – HMO 6-Tier

Refer to this list for drug coverage information for BCN members with a 6-Tier benefit whose plan uses the Custom Drug List. This drug list is updated monthly.

PDF

Custom Drug List – HMO 3 and 5-Tier

Refer to this list for drug coverage information for BCN members with a 3 or 5-Tier benefit whose plan uses the Custom Drug List. This drug list is updated monthly. For members with a closed benefit design, nonpreferred drugs aren’t covered unless we authorize them as medically necessary.

PDF

Custom Drug List – PPO

Refer to this list for drug coverage information for Blue Cross members whose plan uses the Custom Drug List. This drug list is updated monthly. For members with a closed benefit design, nonpreferred drugs aren’t covered unless we authorize them as medically necessary.

PDF

Custom Drug List Updates

This document includes recent changes that may not yet be reflected on our drug lists.

PDF

Preferred Alternatives for Nonpreferred and Nonformulary (Not Covered) Drugs – Custom Drug List

Refer to this list for suggested covered preferred alternatives for nonpreferred and nonformulary drugs that can be dispensed with lower out-of-pocket costs for members.

PDF

Prior Authorization and Step Therapy Guidelines for Custom Drug List

This document explains coverage criteria for drugs on the Custom Drug List.

PDF

Quantity Limit Program Drug List

This document spells out our quantity limits for certain drugs, such as opioids.

Custom Select Drug Lists

PDF

Custom Select Drug List - PPO

Refer to this list for drug coverage information for Blue Cross members whose plan uses the Custom Select Drug List. This drug list is updated monthly. This list is for small group or individual health plans that began on or after Jan. 1, 2014 and meet the requirements of the Patient Protection and Affordable Care Act.

PDF

Custom Select Drug List – HMO

Refer to this list for drug coverage information for BCN members whose plan uses the Custom Select Drug List. This drug list is updated monthly. This list is for small group or individual health plans that began on or after Jan. 1, 2014 and meet the requirements of the Patient Protection and Affordable Care Act.

PDF

Custom Select Drug List Updates

This document includes recent changes that may not yet be reflected on our drug lists.

PDF

Preferred Alternatives for Nonpreferred and Nonformulary (Not Covered) Drugs – Custom Select Drug List

Refer to this list for suggested covered preferred alternatives for nonpreferred and nonformulary drugs that can be dispensed with lower out-of-pocket costs for members.

PDF

Prior Authorization and Step Therapy Guidelines for Custom Select Drugs

This document explains coverage criteria for drugs on the Custom Select Drug List.

PDF

Quantity Limit Program Drug List

This document spells out our quantity limits for certain drugs, like opioids.

Preferred Drug Lists

PDF

Preferred Drug List

Refer to this list for drug coverage information for Blue Cross and BCN members whose plan uses the Preferred Drug List. This drug list is updated monthly.

PDF

Preferred Drug List Updates

This document includes recent changes that may not yet be reflected on our drug lists.

PDF

Preferred Alternatives for Nonpreferred and Nonformulary (Not Covered) Drugs – Preferred Drug List

Refer to this list for suggested covered preferred alternatives for nonpreferred and nonformulary drugs that can be dispensed with lower out-of-pocket costs for members.

PDF

Prior Authorization and Step Therapy Guidelines for Preferred Drug List

This document explains coverage criteria for drugs on the Preferred Drug list.

PDF

Quantity Limit Program Drug List

This document spells out our quantity limits for certain drugs, like opioids.

Preventive Drug List

PDF

Preventive Drug List

Refer to this list for the drugs and products covered by Blue Cross and BCN at no out-of-pocket cost to members and comply with health care reform’s preventive benefits requirements.

Medicare plans

Medicare Plus Blue PPO

PDF

Medicare Plus Blue PPO Comprehensive Formulary

This lists the drugs we cover for Medicare Plus Blue PPO plans.

PDF

Medicare Plus Blue PPO Formulary Updates

This list is updated monthly to keep you informed of changes

PDF

Medicare Plus Blue PPO Prior Authorization and Step Therapy Guidelines

This document explains coverage criteria for certain drugs.

BCN Advantage HMO and HMO-POS

PDF

BCN Advantage Comprehensive Formulary

This lists the drugs we cover for BCN Advantage plans including HMO ConnectedCare, HMO-POS Classic, HMO-POS Prestige and HMO-POS Prime Value.

PDF

BCN Advantage Formulary Updates

This list is updated monthly to keep you informed of changes.

PDF

BCNA HMO-POS and HMO Prior Authorization and Step Therapy Guidelines

This document explains coverage criteria for certain drugs.

PDF

BCN Advantage HMO-POS Healthy Value Comprehensive Formulary

This lists the drugs we cover for BCN Advantage Community Value.

PDF

BCN Advantage HMO-POS Healthy Value Formulary Updates

This list is updated monthly to keep you informed of changes.

PDF

BCN Advantage HMO-POS Healthy Value Prior Authorization and Step Therapy Guidelines

This document explains coverage criteria for certain drugs.

Prescription Blue PDP

PDF

Prescription Blue PDP Core Comprehensive Formulary

This lists the drugs we cover for Prescription Blue PDP Select.

PDF

Prescription Blue PDP Core Formulary Updates

This list is updated monthly to keep you informed of changes

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Prescription Blue PDP Core Prior Authorization and Step Therapy Guidelines

This document explains coverage criteria for certain drugs.

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Prescription Blue PDP Standard Comprehensive Formulary

This lists the drugs we cover for Prescription Blue PDP Premium.

PDF

Prescription Blue PDP Standard Formulary Updates

This list is updated monthly to keep you informed of changes

PDF

Prescription Blue PDP Standard Prior Authorization and Step Therapy Guidelines

This document explains coverage criteria for certain drugs.

Medicare Plus Blue Group PPO

PDF

Group Comprehensive Formulary

This lists the comprehensive drugs we cover for Medicare Plus Blue Group and Prescription Blue Group PDP plans.

PDF

Group Enhanced Comprehensive Formulary

This lists the enhanced comprehensive drugs we cover for Medicare Plus Blue Group and Prescription Blue Group PDP plans.

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Group Comprehensive and Enhanced Formulary Updates

This list is updated monthly to keep you informed of changes.

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Group Comprehensive and Enhanced Prior Authorization and Step Therapy Guidelines

This document explains coverage criteria for certain drugs.

PDF

Group Standard Comprehensive Formulary

This lists the standard comprehensive drugs we cover for Medicare Plus Blue Group and Prescription Blue Group PDP plans.

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Group Standard Enhanced Comprehensive Formulary

This lists the standard enhanced comprehensive drugs we cover for Medicare Plus Blue Group and Prescription Blue Group PDP plans.

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Group Standard Comprehensive and Standard Enhanced Formulary Updates

This list is updated monthly to keep you informed of changes.

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Group Standard Comprehensive and Standard Enhanced Prior Authorization Guidelines

This document explains coverage criteria for certain drugs.

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Group Plus Comprehensive Formulary

This lists the plus comprehensive drugs we cover for Medicare Plus Blue Group and Prescription Blue Group PDP plans.

PDF

Group Plus Comprehensive Formulary Updates

This list is updated monthly to keep you informed of changes.

PDF

Group Plus Comprehensive Prior Authorization and Step Therapy Guidelines

This document explains coverage criteria for certain drugs.

BCN Advantage Group HMO and HMO-POS

PDF

BCN Advantage Group Formulary

This lists the drugs covered under group BCN Advantage plans.

PDF

BCN Advantage Group Formulary Updates

This list is updated monthly to keep you informed of changes.

PDF

BCN Advantage Group Prior Authorization and Step Therapy Guidelines

This document explains coverage criteria for certain drugs.

Prescription Blue Group PDP

PDF

Group Comprehensive Formulary

This lists the drugs covered under group Prescription Blue Group PDP plans.

PDF

Group Enhanced Comprehensive Formulary

This lists the drugs covered under group Prescription Blue Group PDP plans.

PDF

Group Comprehensive and Enhanced Formulary Updates

This list is updated monthly to keep you informed of changes.

PDF

Group Comprehensive and Enhanced Prior Authorization and Step Therapy Guidelines

This document explains coverage criteria for certain drugs.

PDF

Group Standard Comprehensive Formulary

This lists the drugs covered under group Prescription Blue Group PDP plans.

PDF

Group Standard Enhanced Comprehensive Formulary

This lists the drugs covered under group Prescription Blue Group PDP plans.

PDF

Group Standard Comprehensive and Standard Enhanced Formulary Updates

This list is updated monthly to keep you informed of changes.

PDF

Group Standard Comprehensive and Standard Enhanced Prior Authorization and Step Therapy Guidelines

This document explains coverage criteria for certain drugs.

PDF

Group Plus Comprehensive Formulary

This lists the drugs covered under group Prescription Blue Group PDP plans.

PDF

Group Plus Comprehensive Formulary Updates

This list is updated monthly to keep you informed of changes.

PDF

Group Plus Comprehensive Prior Authorization and Step Therapy Guidelines

This document explains coverage criteria for certain drugs.