800-843-4876, C.O.P.S. www.eyemedvisioncare.com/som, Flexible Savings Account (FSA) This list is updated monthly to keep you informed of changes. The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. For questions about the CoverMyMeds web tool, call the CoverMyMeds support center at 1-866-452-5017. www.bcbsm.com/som, State HDHP with HSA Benefit Booklet HealthEquity Health Savings Account (HSA) When you submit your pharmacy drug authorization requests electronically, there are many benefits compared to faxing your request: Below, you'll find information on how to submit a pharmacy drug prior authorization request electronically for Blue Cross commercial and Medicare Plus Blue members. Self-service or a voicemail can be used 24 hours a day, seven days a week, including weekends and holidays. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. Register Now, Not registered? Register Now, Not registered? Blue Cross Medicare Advantage Choice Plus (PPO) SM. Refer to this list for drug coverage information for BCN members whose plan uses the Custom Select Drug List. Qualified Transportation Fringe Benefits (QTFB). Active Employees We provide health insurance in Michigan. This page offers resources for providers requesting prior authorization or an exception from other utilization management requirements for drugs covered under the pharmacy benefit. This lists the comprehensive drugs we cover for Medicare Plus Blue Group and Prescription Blue Group PDP plans. Below is our drug list and updates: Non-Medicare plans Clinical Drug Lists PDF Clinical Drug List They list all the drugs covered by your plan. Refer to this list for drug coverage information for BCN members with a 3 or 5-Tier benefit whose plan uses the Custom Drug List. Plus Drug Formulary for the following California Department of Insurance (CDI) grandfathered plans: Active Start Plan 35-G, Balance Plan 1000-G, Balance Plan 1700-G, Balance Plan 2500-G, Shield Savings 5200-G, Shield Savings 1800/3600-G, Shield Savings 3500-G . 517-364-8500 Refer to this list for drug coverage information for Blue Cross members whose plan uses the Custom Drug List. America is facing an affordability crisis when it comes to our health care. www.phpsom.com, Catastrophic Health Use these documents to find drug coverage information, as well as prior authorization or step therapy requirements, for your Blue Cross Blue Shield of Michigan, Blue Care Network and Medicare Advantage patients. This lists the drugs we cover for Prescription Blue PDP Premium. Step Therapy Criteria tells you about cases in which you might need to try lower-cost drugs before we'll cover a specific drug. Click, For group plans, scroll down to the heading "If you get your insurance through an employer, union or other group, use these drug lists." Health Trust (MSPTA represented only) Health Alliance Plan (HAP) Priority Health Additional Health Plan Resources Plan Comparisons This lists the drugs covered under group Prescription Blue Group PDP plans. Not registered? Login or Register here. 1996-2023 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. For Blue Cross commercial fully insured members, including MESSA members. This lists the enhanced comprehensive drugs we cover for Medicare Plus Blue Group and Prescription Blue Group PDP plans. Blue Cross Blue Shield of Michigan (BCBSM) www.bcbsm.com/som, McLaren Health Plan Note: These booklets are not a contract. For medical oncology and supportive care drugs, submit prior authorization requests to Carelon Medical Benefits Management (formerly AIM Specialty Health ). This document spells out our quantity limits for certain drugs, such as opioids. For Blue Cross commercial members only, mail the request to: For questions about utilization management requirements, call the Blue Cross / BCN Pharmacy Clinical Help Desk at 1-800-437-3803. Refer to this list for suggested covered preferred alternatives for nonpreferred and nonformulary drugs that can be dispensed with lower out-of-pocket costs for members. Log in atwww.bcbsm.com/somto manage your HSA from HealthEquity. Tips to stay covered, As health care costs rise, a plan to save Americans over $700 billion, How to save three-quarters of a trillion dollars in health care costs. All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members. 866-633-6433. Refer to this list for drug coverage information for Blue Cross members whose plan uses the Custom Select Drug List. If you receive insurance through an employer, please enter the ZIP code or select the state of the employer's headquarters to view the BCBS companies serving that region. This drug list is updated monthly. Preferred drug list Copays We cover the medicines on our Preferred Drug List (PDF). Follow these steps to submit prior authorization requests when prescribing drugs covered under the medical benefit for Blue Cross Blue Shield of Michigan and Blue Care Network commercial members. We are available seven (7) days a week. Important Information About Medicare Plans 1996-2021 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. 877-867-5781, Group Employee & Dependent Life Insurance Certificate. However, if statements in this description differ from the applicable coverage documents, then the terms and conditions of those documents will prevail. If you leave a voice . You'll find out how many tiers your plan has and what you pay for each tier. Leading the way in health insurance since 1929. If you do not receive your insurance though an employer, please enter the ZIP code for where you live. Michigans prior authorization law* requires health care providers to submit prior authorization requests electronically for commercial members. Important Legal and Privacy Information | Important Information About MedicarePlans | Privacy Practices | Site Map | Feedback | Download Adobe Acrobat Reader, Important Information About MedicarePlans. This lists the standard comprehensive drugs we cover for Medicare Plus Blue Group and Prescription Blue Group PDP plans. Copay Structure Register Now, Learn more about registering for our web tools. The enclosed formulary is current as of 09/01/2020. 866-503-3158 (New Directions), Optum Rx (State HDHP with HSA) This document includes recent changes that may not yet be reflected on our drug lists. Data driven insights, stories of inspired healthcare solutions and the interactive BCBS Health Index. Learn More As health care costs rise, a plan to save Americans over $700 billion This lists the drugs we cover for Medicare Plus Blue PPO plans. Get access to your employer portal. You can call this number from 8:30 a.m. until 6 p.m., We require that generic medicines be used when available. If youre experiencing temporary technical problems (such as a power or internet outage) that prevent you from submitting prior authorization requests through an ePA tool, submit prior authorization requests to Blue Cross or BCN using one of the following methods: *Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. Get access to your online account. Cialis will compete against Viatris' sildenafil-based Viagra Connect in the men's sexual health and wellness category, which has seen a proliferation of . Some drugs require prior authorization before they can be dispensed to a Blue Cross commercial or Medicare Plus BlueSM member. 888-327-0671 Over the last 20 years, the United States has made great strides in expanding access to care, with 92% of Americans now covered by health insurance a historic high. Our call center is open Monday-Friday 8:00 a.m. - 8:00 p.m. Central time. Get access to your employer portal.Register Now, Learn more about registering for our web tools.Register Now, Not registered? To determine individual eligibility for HMO health plans, use theHMO ZIP Code Tool. While we recommend this site, we're not responsible for its content. 800-662-6667 248-524-0454 This list can help your doctor select medicines for you. www.deltadentalmi.com/som, 2023 State Dental Plan Blue Cross Blue Shield The Preferred Drug List, known as the drug formulary, is the list of medicines we cover. 877-284-9840 Enter the first three letters of the Identification Number from your member ID card. For questions about the CoverMyMeds web tool, call the CoverMyMeds support center at 1-866-452-5017. This document explains coverage criteria for certain drugs. 866-503-3158 (Lucet), Optum Rx (SHP PPO) member portal, emails, and other materials. We require the generic medicines be used when available. Get access to your online account.Register Now, Not registered? Rx Medication Search Dental Plan Comparison Chart, 2022 State Dental Plan 800-843-4876 (BCBSM), Authorizations or Referrals This lists the plus comprehensive drugs we cover for Medicare Plus Blue Group and Prescription Blue Group PDP plans. www.healthequity.com/wageworks, the This document explains coverage criteria for drugs on the Preferred Drug list. To learn how to submit an ePA request using CoverMyMeds, see the following documents: To help you learn to use the CoverMyMeds web tool: For Providers: Drug Lists page on bcbsm.com, Coverage Request Form for nonformulary or benefit exception requests, Michigan Authorization Request Form for Prescription Drugs* (PDF), Drugs: For medication adherence, medical benefit drugs and pharmacy benefit drugs (PDF), Alternate methods for submitting prior authorization requests for pharmacy benefit drugs. Call 1-877-860-2837(TTY/TDD:711) We are open 24 hours a day, seven (7) days a week. Dental Plan Comparison Chart Cialis Together 10mg Tablets - Tadalafil - 4 Tablets. State HDHP with HSA Benefits-at-a-Glance, Behavioral Health/Substance Use Disorder (BH/SUD) Administrator for the State HDHP, Blue Cross Blue Shield of Michigan (BCBSM) in partnership with New Directions, Authorizations or Referrals The web Browser you are currently using is unsupported, and some features of this site may not work as intended. 800-843-4876 Preventive Dental Plan Find the health insurance option that is right for you, your family, or your business. 800-446-5674 ), 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, For individual plans, scroll down to the heading If you're buying your own insurance, use these drug lists. 1 Blue Cross Blue Shield of Michigan Custom Select Drug List The Blue Cross Blue Shield of Michigan Custom Select Drug List is a useful reference and educational tool for prescribers, pharmacists and members. In addition, an ePA tool can be integrated into your current electronic health record workflow. State Health Plan PPO Refer to this list for drug coverage information for Blue Cross members whose plan uses the Clinical Drug List. Both generic and brand name medicines are on the list. of Michigan (BCBSM) Blue Cross Blue Shield 800-324-9901, Employee & Dependent Life Insurance Learn more about how to read a drug list. On weekends and Federal holidays, voice messaging is available. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. This list is for small group or individual health plans that began on or after Jan. 1, 2014 and meet the requirements of the Patient Protection and Affordable Care Act. Identify Blue Cross commercial utilization management (step therapy or authorization) requirements by reviewing the following: For Medicare Plus Blue members, select from below: How to identify utilization management requirements for Medicare Plus Blue. This drug list is updated monthly. For questions about utilization management requirements, call the Blue Cross / BCN Pharmacy Clinical Help Desk at 1-800-437-3803. Carelon-Managed Procedures (formerly AIM), Blue Cross PPO and BCN HMO prior authorization and step therapy coverage criteria, Blue Cross PPO and BCN HMO prior authorization and step therapy coverage criteria for the Preferred Drug List, Save time and submit your prior authorization requests electronically for pharmacy benefit drugs, Michigan Authorization Request Form for Prescription Drugs, Drugs: For medication adherence, medical benefit drugs and pharmacy benefit drugs, Approvals within minutes (Some requests require more time. Blue Cross Blue Shield of Michigan (BCBSM) in partnership with Lucet, Inquiries for Benefits, Claims, or ID Cards Note:HealthEquityacquired WageWorks. of Michigan (BCBSM) We update these documents each year. We regularly update this list with medications approved by the U.S. Food and Drug Administration and reviewed by our Individuals attempting unauthorized access will be prosecuted. Active and MSPTA Plan Booklet As a current member, you can access your benefits and services from your local Blue Cross Blue Shield company. IMPORTANT! www.priorityhealth.com/som. For members with a closed benefit design, nonpreferred drugs arent covered unless we authorize them as medically necessary. It's best to get this information in your member account on our website. Underwritten by Minnesota Life Insurance Company The formulary, also known as a drug list, for each Blue MedicareRx plan includes most eligible generic and brand-name drugs. This lists the drugs we cover for BCN Advantage plans including HMO ConnectedCare, HMO-POS Classic, HMO-POS Prestige and HMO-POS Prime Value. The formulary, or drug list, is the main source. 800-524-0150 Health Trust Your 2023 Blue Cross Blue Shield of Michigan Custom Drug List If you have questions, call the number on the back of your member ID card to: Find a participating retail pharmacy by ZIP code Look up lower-cost medication alternatives Compare medication pricing and options Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees Search to see drugs covered under this Benefit Plan. For Blue Cross commercial members, select from below: How to identify utilization management requirements for Blue Cross commercial. Use these documents to find drug coverage information, as well as prior authorization or step therapy requirements, for your Blue Cross Blue Shield of Michigan, Blue Care Network and Medicare Advantage patients. 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