For Providers: Drug Lists

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.

 

Non-Medicare plans

PDF

Clinical Drug List

Refer to this list for drug coverage information for Blue Cross members whose plan uses the Clinical Drug List. This drug list is updated monthly.

PDF

Clinical Drug List Updates

This document includes recent changes that may not yet be reflected on our drug lists.

PDF

Preferred Alternatives for Nonpreferred and Nonformulary (Not Covered) Drugs – Clinical Drug List

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.

PDF

Prior Authorization and Step Therapy Guidelines for Clinical Drug List

This document explains coverage criteria for drugs on the Clinical Drug List.

PDF

Quantity Limit Program Drug List

This document spells out our quantity limits for certain drugs, like opioids.

PDF

Custom Drug List - HMO

Refer to this list for drug coverage information for BCN members whose plan uses the Custom Drug List. This drug list is updated monthly. For members with a closed benefit design, nonpreferred drugs aren’t covered unless we authorize them as medically necessary.

PDF

Custom Drug List – PPO

Refer to this list for drug coverage information for Blue Cross members whose plan uses the Custom Drug List. This drug list is updated monthly. For members with a closed benefit design, nonpreferred drugs aren’t covered unless we authorize them as medically necessary.

PDF

Custom Drug List Updates

This document includes recent changes that may not yet be reflected on our drug lists.

PDF

Preferred Alternatives for Nonpreferred and Nonformulary (Not Covered) Drugs – Custom Drug List

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.

PDF

Prior Authorization and Step Therapy Guidelines for Custom Drug List

This document explains coverage criteria for drugs on the Custom Drug List.

PDF

Quantity Limit Program Drug List

This document spells out our quantity limits for certain drugs, such as opioids.

PDF

Custom Select Drug List - PPO

Refer to this list for drug coverage information for Blue Cross members whose plan uses the Custom Select Drug List. This drug list is updated monthly. 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.

PDF

Custom Select Drug List – HMO

Refer to this list for drug coverage information for BCN members whose plan uses the Custom Select Drug List. This drug list is updated monthly. 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.

PDF

Custom Select Drug List Updates

This document includes recent changes that may not yet be reflected on our drug lists.

PDF

Preferred Alternatives for Nonpreferred and Nonformulary (Not Covered) Drugs – Custom Select Drug List

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.

PDF

Prior Authorization and Step Therapy Guidelines for Custom Select Drugs

This document explains coverage criteria for drugs on the Custom Select Drug List.

PDF

Quantity Limit Program Drug List

This document spells out our quantity limits for certain drugs, like opioids.

PDF

Preferred Drug List

Refer to this list for drug coverage information for Blue Cross and BCN members whose plan uses the Preferred Drug List. This drug list is updated monthly.

PDF

Preferred Drug List Updates

This document includes recent changes that may not yet be reflected on our drug lists.

PDF

Preferred Alternatives for Nonpreferred and Nonformulary (Not Covered) Drugs – Preferred Drug List

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.

PDF

Prior Authorization and Step Therapy Guidelines for Preferred Drug List

This document explains coverage criteria for drugs on the Preferred Drug list.

PDF

Quantity Limit Program Drug List

This document spells out our quantity limits for certain drugs, like opioids.

PDF

Preventive Drug List

Refer to this list for the drugs and products covered by Blue Cross and BCN at no out-of-pocket cost to members and comply with health care reform’s preventive benefits requirements.

 

Medicare plans

Visit Drug Lists for Medicare Plans to view all our Medicare formularies, updates, and prior authorization and step therapy guidelines.