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Medical Benefit and Pharmacy BenefitDrugs

Medical Benefit Drugs

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Pharmacy Benefit Drugs

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Some drugs require prior authorization before they can be delivered or administered in a health care provider's office, clinic, outpatient or home setting and some drugs require prior authorization before they can be dispensed.

Did you know?

When you submit prior authorization requests for medical and pharmacy benefit drugs electronically, there are many benefits compared to faxing requests:

  • Faster response times on your requests
  • Approvals within minutes (Some requests require more time.)
  • Reduced administrative time
  • Streamlined questions, asking only those needed for the authorization
  • The ability to attach documentation if required
  • Clinical criteria to guide you in submitting the proper information
  • Secure and efficient prior authorization administration all in one place
  • The capability of renewing existing authorizations up to 60 days before they expire

Important:

Always verify eligibility and benefits for each member at each visit. A prior authorization approval is not a guarantee of payment.

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.