Comprehensive lists of requirements available for medical specialty drugs and pharmacy benefit drugs

We've developed comprehensive lists of requirements for medical specialty drugs and pharmacy benefit drugs for Blue Cross Blue Shield of Michigan PPO and Blue Care Network HMO commercial members. These lists, which are typically updated monthly, include the most current information on utilization management requirements.

• Medical benefit drugs: The medical specialty drug list identifies medical drugs targeted in the prior authorization and site-of-care programs, and includes the following information about them:
  • Medical necessity criteria
  • Quantity limits
  • Step therapy requirements
• Pharmacy benefit drugs: The pharmacy benefit drug list identifies pharmacy drugs targeted in the prior authorization program and includes step therapy requirements.

For more information, see the following articles:

• Comprehensive lists of requirements for medical specialty drugs and pharmacy benefit drugs available in the July 2019 issue of The Record
• Enhanced documents now available for Blue Cross and BCN commercial utilization management requirements for medical and pharmacy benefit drugs on page 27 of the July-August 2019 issue of BCN Provider News

Posted: July 2019
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network