We've improved the commercial Blue Cross and BCN utilization management medical drug list

We've published updated documents with utilization management information about drugs covered under the medical benefit for Blue Cross Blue Shield of Michigan and Blue Care network commercial members.

Based on feedback we received from providers and others, we've made changes so the information will be more accessible, clear, transparent and streamlined:

• The redesigned Blue Cross and BCN utilization management medical drug list (PDF):
  • Offers a fuller explanation of our medical-drug utilization management programs for commercial members
  • Indicates more clearly where to submit prior authorizations requests — to AIM Specialty Health^® or through the NovoLogix^® online tool
  • Continues to indicate which drugs have prior authorization and site-of-care requirements that apply to Blue Cross or BCN commercial members
  • Continues to show the preferred and nonpreferred products for drugs for which we've designated preferred products
  • No longer contains medical policy information or information about documentation requirements, which makes the list shorter and easier to use
• The quantity limits information is in its own document, titled Blue Cross and BCN quantity limits for medical drugs (PDF):
  • This separate document provides easier access for providers who need only the quantity limits.
  • This document continues to indicate whether the quantity limits apply to in-state or out-of-state providers or both
  • The Blue Cross and BCN utilization management medical drug list includes a link to the Blue Cross and BCN quantity limits for medical drugs document in the introductory text and in the table heading on each page.

We've published both lists on bcbsm.com, on the page titled Why do I need prior authorization for a prescription drug? Under the "How do I find out if my medication needs prior authorization?" heading, click Medical coverage drugs.

We'll also make these lists available at ereferrals.bcbsm.com:

• On the Blue Cross Medical Benefit Drugs page
• On the BCN Medical Benefit Drugs page

You'll also be able to find these lists behind the provider portal.

We appreciate the feedback we received from the provider community and encourage additional comments on the new documents. Blue Cross and BCN are committed to providing reliable, up-to-date, easy-to-use resources, to help navigate the medical-benefit drug utilization management programs we have in place.

Posted: December 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network