Drugs Covered Under the Medical Benefit

BCN providers use the NovoLogix electronic system to submit specialty medical drug authorization requests for members covered under BCN HMOSM (commercial) and BCN AdvantageSM plans. BCN no longer accepts these requests through the e-referral system.

The resource documents on this page will guide you in submitting these requests to NovoLogix.

NovoLogix is an independent company with a web-based tool used to request prior authorization for specialty medical medications.

Training resources

Authorization and medical necessity criteria resources

Billing/pricing information - for BCN commercial members only

Other information

If you need assistance, you can contact the Pharmacy Help Desk:

  • By phone: 1-800-437-3803
  • By fax:
    • For BCN HMO (commercial) members, fax to 1-877-325-5979.
    • For BCN Advantage members, fax to 1-866-392-6465.

You can refer to the Pharmacy chapter of the BCN Provider Manual for additional information about drugs covered under the medical benefit. Here's how to access the information in the Pharmacy chapter:

  1. Visit bcbsm.com/providers and click Login.
  2. Log in as a provider, using your user name and password.
  3. Click BCN Provider Publications and Resources.
  4. Click Provider Manual.
  5. Click Pharmacy.
  6. Look in the section titled "Drugs covered under the medical benefit."

Here are some of the topics you can read about in the Pharmacy chapter:

  • Examples of drugs covered under the medical benefit
  • Requesting authorization for drugs administered in specialty clinics or practitioners' offices
  • Purchasing drugs for administration in specialty clinics or practitioners' offices
  • NDC pricing and billing for drugs administered in practitioners' offices and in home settings
  • Billing for medications administered at outpatient infusion centers
  • Maximum payable amounts

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