Starting Dec. 1, some drugs covered under the medical benefit will require authorization for Blue Cross and Blue Shield Federal Employee Program^® non-Medicare members

For dates of service on or after Dec. 1, 2020, providers will have to request authorization from Blue Cross Blue Shield of Michigan for some drugs covered under the medical benefit for Blue Cross and Blue Shield Federal Employee Program non-Medicare members. Authorization will be required only when members receive the drugs in Michigan.

The drugs that will require authorization are listed in the Utilization management medical drug list for Blue Cross and Blue Shield Federal Employee Program non-Medicare members (PDF) document.

Note: For dates of service prior to Dec. 1, 2020, authorization isn't required for drugs covered under the medical benefit for Blue Cross and Blue Shield FEP non-Medicare members.

What you need to do

• Request authorization from Blue Cross for members affected by this change.
• Verify that members have active coverage on the date of service and that medications and services are covered under the Blue Cross and Blue Shield FEP.

Resources

The Blue Cross and Blue Shield FEP has its own policies for drugs that require authorization. The policies are available on the Medical Policies page of the Blue Cross and Blue Shield Federal Employee Program website.

In mid-October, we'll make available the list of medical benefit drugs that require authorization for Blue Cross and Blue Shield FEP non-Medicare members. Look for the list on the Blue Cross Drugs covered under the medical benefit page of this website.

Look for additional information in web-DENIS messages and in future issues of The Record.

How to submit authorization requests

You can submit authorization requests using one of the following methods:

• By fax: Starting Nov. 1, you can submit authorization requests by fax. For information about the forms you'll use to submit authorization requests, contact the Pharmacy Clinical Help Desk at 1-800-437-3803.
• Online through the NovoLogix^® online tool. Starting Dec. 1, 2020, you can submit authorization requests through NovoLogix. The tool offers real-time status checks and immediate approvals for certain medications.

To learn how to submit requests through NovoLogix, click Blue Cross from within this website and then click Medical Benefit Drugs. In the Blue Cross PPO (commercial) column, see the "How to submit authorization requests electronically using NovoLogix" section.

Additional information

Authorization isn't a guarantee of payment. Health care practitioners need to verify eligibility and benefits for members.

This list above applies only to Blue Cross and Blue Shield FEP non-Medicare members.

For requirements related to drugs covered under the medical benefit for other Blue Cross' PPO (commercial) members and for BCN HMO^SM (commercial) members, see the following pages of this website:

• Blue Cross Drugs Covered Under the Medical Benefit
• BCN Drugs Covered Under the Medical Benefit

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**CPT codes, descriptions and two-digit numeric modifiers only are copyright 2019 American Medical Association. All rights reserved.

Posted: September 2020
Line of business: Blue Cross Blue Shield of Michigan