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Medical Benefit Drugs

Determine requirements for most drugs

Determine requirements for oncology drugs

Medication Authorization Request Forms

Resources

Prior authorization requirements for medical benefit drugs vary according to the type of drug and the member's coverage:

Type of drug	Members	Submit requests through
Most drugs, including requests for gene and cellular therapy drugs	Blue Cross Blue Shield of Michigan commercial and Blue Care Network commercial To determine which Blue Cross commercial self-funded groups have opted in to the standard commercial drug program, see Group opt in/opt out list. Note: For Blue Cross and Blue Shield Federal Employee Program^® non-Medicare members, you can submit requests through the Medical and Pharmacy Drug PA Portal or by fax. For information about faxing prior authorization requests, call the Pharmacy Clinical Help Desk at 1-800-437-3803. Medicare Plus Blue^℠ and BCN Advantage^℠	Medical and Pharmacy Drug PA Portal, which is accessed by clicking the Medical and Pharmacy Benefit Drug Prior Auth tile in our provider portal (availity.com)
Oncology drugs	Blue Cross commercial and BCN commercial To determine which self-funded groups have requirements under the program, see the Oncology Value Management program participation list for commercial self-funded groups.	For most members: OncoHealth OneUM^™ prior authorization portal For Blue Cross commercial UAW Retiree Medical Benefits Trust members: Carelon Medical Benefits Management provider portal For MESSA members and Blue Cross and Blue Shield Federal Employee Program^®: Not applicable. Medical oncology and supportive care drugs don’t require prior authorization
Medicare Plus Blue and BCN Advantage	OncoHealth OneUM prior authorization portal

Type of drug

Members

Submit requests through

Most drugs, including requests for gene and cellular therapy drugs

Blue Cross Blue Shield of Michigan commercial and Blue Care Network commercial

To determine which Blue Cross commercial self-funded groups have opted in to the standard commercial drug program, see Group opt in/opt out list.
Note: For Blue Cross and Blue Shield Federal Employee Program^® non-Medicare members, you can submit requests through the Medical and Pharmacy Drug PA Portal or by fax. For information about faxing prior authorization requests, call the Pharmacy Clinical Help Desk at 1-800-437-3803.

Medicare Plus Blue^℠ and BCN Advantage^℠

Medical and Pharmacy Drug PA Portal, which is accessed by clicking the Medical and Pharmacy Benefit Drug Prior Auth tile in our provider portal (availity.com)

Oncology drugs

Blue Cross commercial and BCN commercial

To determine which self-funded groups have requirements under the program, see the Oncology Value Management program participation list for commercial self-funded groups.

For most members: OncoHealth OneUM^™ prior authorization portal

For Blue Cross commercial UAW Retiree Medical Benefits Trust members: Carelon Medical Benefits Management provider portal

For MESSA members and Blue Cross and Blue Shield Federal Employee Program^®: Not applicable. Medical oncology and supportive care drugs don’t require prior authorization

Medicare Plus Blue and BCN Advantage

OncoHealth OneUM prior authorization portal

How to submit prior authorization requests

To learn how to submit requests, see our Getting Started page.

Submit requests before providing services.

Utilization Management Criteria

Visit our Utilization Management Criteria page.

Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.

OncoHealth is an independent company supporting Blue Cross Blue Shield of Michigan and Blue Care Network by providing cancer support services.