Some drugs require prior authorization before they can be dispensed to a BCN commercial or BCN AdvantageSM member.
This page offers resources for providers requesting prior authorization or an exception from other utilization management requirements for drugs covered under the pharmacy benefit.
Did you know?
Michigan’s prior authorization law* requires health care providers to submit prior authorization requests electronically for commercial members. Alternate submission methods are allowed in the case of temporary technological problems, such as power or internet outages; see the information about submitting prior authorization requests through alternate methods below.
When you submit your pharmacy drug authorization requests electronically, there are many benefits compared to faxing your request:
Below, you'll find information on how to submit a pharmacy drug prior authorization request electronically for BCN commercial and BCN Advantage members. You'll also find other helpful resources.
IMPORTANT! Always verify eligibility and benefits for each member at each visit.
For BCN commercial members, select from below:
How to identify utilization management requirements for BCN commercial
Identify BCN commercial utilization management (step therapy or authorization) requirements by reviewing the following:
For BCN Advantage members, select from below:
How to identify utilization management requirements for BCN Advantage
Identify BCN Advantage utilization management (step therapy or authorization) requirements by reviewing the following:
How to submit an electronic prior authorization, or ePA, request
You can use CoverMyMeds® and other free ePA tools such as Surescripts®* to submit prior authorization requests for most pharmacy benefit drugs. In addition, an ePA tool can be integrated into your current electronic health record workflow. Check your vendor to see if you have software that accommodates an ePA tool.
To learn how to submit an ePA request using CoverMyMeds, see the following documents:
- For Blue Cross commercial and BCN commercial: Save time and submit your prior authorization requests electronically for pharmacy benefit drugs (PDF)
- For Medicare Plus Blue and BCN Advantage: Save time and submit your prior authorization requests electronically for pharmacy benefit drugs (PDF)
To help you learn to use the CoverMyMeds web tool:
- See the CoverMyMeds Prescriber Demonstration*.
- Register for a complimentary 15-minute webinar held every Tuesday, Wednesday and Thursday: CoverMyMeds physician office training*.
For Providers: Drug Lists page on bcbsm.com
Coverage Request Form — for nonformulary or benefit exception requests
Quality Limit Request form (PDF)
Michigan Authorization Request Form for Prescription Drugs* (PDF)
Drugs: For medication adherence, medical benefit drugs and pharmacy benefit drugs (PDF)
Alternate methods for submitting prior authorization requests for pharmacy benefit drugs
If you’re experiencing temporary technical problems (such as a power or internet outage) that prevent you from submitting prior authorization requests through an ePA tool, submit prior authorization requests to Blue Cross or BCN using one of the following methods:
- For BCN commercial members, fax to 1-866-601-4425.
- For BCN Advantage members, fax to 1-800-459-8027.
- Call the Blue Cross and BCN Pharmacy Clinical Help Desk at 1-800-437-3803.
- For BCN commercial members only, mail the request to:
BCBSM Clinical Help Desk
P.O. Box 312320
Detroit, MI 48231-2320
Need additional assistance?
Here's who you can call:
- For questions about utilization management requirements, call the Blue Cross / BCN Pharmacy Clinical Help Desk at 1-800-437-3803.
- For questions about the CoverMyMeds web tool, call the CoverMyMeds support center at 1-866-452-5017.
*Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're not responsible for its content.