Blue Cross Blue Shield - Michigan Prior Authorization Lookup
- Blue Cross Blue Shield - Michigan coverage criteria
- All Blue Cross Blue Shield - Michigan policy updates
Latest Blue Cross Blue Shield - Michigan prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Acitretin and selected specialty drug prior authorization and step therapy criteriaOutlines prior authorization and step therapy requirements, coverage durations (commonly 1 year), prerequisite Part D drug and documentation expectations for acitretin and multiple specialty/Part D products for Medicare Plus Blue Group PDP/PPO plans.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Acitretin prior authorization and coverage summaryThis document lists prior authorization (PA) and step therapy (ST) requirements for acitretin and other drugs under the Blue Cross Blue Shield of Michigan Medicare Plus Blue Group PPO and Prescription Blue Group PDP formulary; it applies to plan members and their prescribing providers seeking coverage for these medications.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Adapalene (topical gel) coveragePrior authorization and step therapy rules for Adapalene products on BCBSM Medicare Plus Blue and Prescription Blue Group formularies; applies to prescribers and pharmacists managing member medication coverage.All blue cross blue shield - michigan updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-07-0115-Day Specialty Drug Limitation ProgramLimits days' supply for listed specialty drugs for BCBSM and BCN members: initial six fills are limited to 15-day supplies, with the seventh fill permitted as 15- or 30-day (or plan default). Applicable to members subject to the payer's pharmacy coverage and may require prior authorization.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Acitretin prior authorization and coverage summaryThis document lists prior authorization (PA) and step therapy (ST) criteria for Acitretin and many other medications for Blue Cross Blue Shield of Michigan Medicare Plus Blue Group PPO and Prescription Blue Group PDP members; it affects prescribers and pharmacies seeking coverage for these drugs. The Acitretin entry specifies coverage duration and that no prerequisite Part D drug is required.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Acitretin prior authorization and coverage summaryThis document governs prior authorization and step therapy requirements for the drug acitretin (and lists related formulary drugs) for Blue Cross Blue Shield of Michigan Medicare Plus Blue Group PPO and Prescription Blue Group PDP members.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Formulary prior authorization and step therapy list (selected products)Lists medications on the BCBSM Core Comprehensive Formulary 2026 (Medicare Plus Blue PPO) that require prior authorization (PA) or step therapy (ST), with brief coverage requirements and prerequisite therapy notes affecting prescribers and pharmacy benefit administrators.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Medicare Plus Blue Group PPO / Prescription Blue Group PDP — Prior Authorization and Step Therapy Criteria (Pharmacy & Specialty Drugs)Lists prior authorization and step therapy requirements for multiple prescription drugs covered under the BCBSM Medicare Plus Blue Group PPO and Prescription Blue Group PDP Healthy Value Comprehensive Formulary for the 2026 plan year; intended for providers and pharmacists submitting PA/ST requests for affected members.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Medicare Plus Blue Group prior authorization and step therapy criteria (Formulary PA/ST Program 2026)Defines Medicare Plus Blue Group prior authorization and step therapy requirements for prescription drugs included in the 2026 formulary for Blue Cross Blue Shield of Michigan; affects prescribers and pharmacies submitting PA/ST requests for covered Part D medications.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Medicare Plus Blue Prior Authorization and Step Therapy Criteria — Pharmacy & Specialty Drugs (2026 Plan Year)Lists prior authorization and step therapy criteria for Medicare Plus Blue Group PPO and Prescription Blue Group PDP (2026), including product-specific coverage rules, prerequisite therapies, exclusions, age/diagnostic thresholds, documentation and reauthorization requirements.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Prior authorization and step therapy criteria for specialty and pharmacy drugsLists prior authorization and step therapy requirements for multiple prescription drugs under the BCBSM Medicare Plus Blue Group PPO and Prescription Blue Group PDP Healthy Value Enhanced Comprehensive Formulary for the 2026 plan year; affects prescribers and pharmacists seeking drug coverage for plan members.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-012026 Healthy Value Comprehensive Formulary (Medicare drug list)This document is the Medicare Plus Blue Group PPO and Prescription Blue Group PDP 2026 formulary describing covered prescription drugs, member cost-sharing, and coverage rules (prior authorization, step therapy, quantity limits) that apply to plan members and prescribers.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-012026 Healthy Value Enhanced Comprehensive Formulary (Medicare Part D) — Coverage CriteriaDescribes the drugs covered, restrictions (prior authorization, step therapy, quantity limits), and how members or prescribers can request exceptions for Medicare Plus Blue Group PPO and Prescription Blue Group PDP members.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-012026 Prior Authorization and Step Therapy for Medicare Plus Blue PPO Plans (PDF)Part 1 of 6 of BCBS Michigan Medicare Plus Blue PPO 2026 formulary prior authorization and step therapy criteria listing specific drugs with per-drug PA/ST status, coverage durations, prerequisite therapy requirements, indication-specific requirements, age/prescriber restrictions and reauthorization expectations.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Core Comprehensive Formulary — Prior Authorization and Step Therapy Criteria (Part D)Lists medications on the BCBSM Core Comprehensive Formulary that require prior authorization or step therapy, with product-specific coverage conditions, prerequisite therapies, documentation and duration limits for Part D drug coverage.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Medical Drug and Step Therapy Prior Authorization List — Medical benefit drugs requiring prior authorization or step therapyList of medical benefit drugs for Medicare Plus Blue and BCN Advantage members that require prior authorization or have step therapy requirements; intended for providers submitting authorization requests.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Medical Drug and Step Therapy Prior Authorization List — Medicare Plus Blue & BCN AdvantageAll blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Medicare Plus Blue Group PPO & Prescription Blue Group PDP 2026 Formulary (Drug List)This document is the 2026 formulary (drug list) for Medicare Plus Blue Group PPO and Prescription Blue Group PDP and describes which prescription drugs the plans cover, member use instructions, and coverage rules such as prior authorization, quantity limits, step therapy, and exception processes for plan members and providers.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Medicare Plus Blue Group PPO and Prescription Blue Group PDP Formulary (Drug List) — Coverage CriteriaGoverns the 2026 Medicare Part D formulary for Medicare Plus Blue Group PPO and Prescription Blue Group PDP members, describing covered drugs, utilization controls (prior authorization, quantity limits, step therapy), exceptions, and transition supplies.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Medicare Plus Blue PPO 2026 Core Comprehensive Formulary — Prescription Drug Coverage and Utilization ManagementDefines the prescription drugs covered under Blue Cross Blue Shield of Michigan's Medicare Plus Blue PPO Core formulary (effective June 1, 2026) including rules on prior authorization, quantity limits, step therapy, exceptions, and transition supplies; affects Medicare Plus Blue PPO members and their prescribers and network pharmacies.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Prior authorization and step therapy criteria for formulary drugsThis document lists medications on the BCN Advantage HMO-POS Comprehensive Formulary that require prior authorization (PA) or step therapy (ST), and specifies clinical/administrative coverage criteria affecting prescribers and members.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Prior authorization and step therapy criteria for pharmacy & specialty drugs (Formulary PA/ST)This document lists prior authorization and step therapy criteria for multiple prescription drugs on the Blue Cross Blue Shield of Michigan Medicare Group formulary, specifying coverage conditions, prerequisites, duration, and any use restrictions for prescribers and members.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Prior authorization and step therapy criteria — pharmacy & specialty drugsLists drugs subject to prior authorization and step therapy for BCBSM Medicare Plus Blue Group PPO and Prescription Blue Group PDP (2026 plan year), including coverage requirements, prerequisite therapies, age/prescriber restrictions, and durations.All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-012026 Healthy Value Enhanced Comprehensive Formulary (Medicare Plus Blue Group PPO & Prescription Blue Group PDP) — Formulary coverage criteria and utilization controlsThis document is the 2026 Medicare Plus Blue Group PPO and Prescription Blue Group PDP formulary describing covered outpatient prescription drugs, applicable coverage rules (prior authorization, step therapy, quantity limits), member rights for exceptions and transition supplies, and who is affected (plan members and prescribers).All blue cross blue shield - michigan updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01BCN Advantage HMO-POS Comprehensive Formulary Prior Authorization / Step Therapy Program (partial extract, Part 1)Partial extract of the BCN Advantage HMO-POS Group 2026 formulary prior authorization and step therapy criteria listing multiple specific prescription products and per-product coverage conditions, age/prescriber restrictions, coverage durations, prerequisite therapy requirements, and indication-specific additional criteria.All blue cross blue shield - michigan updates
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Tool Description
Search Blue Cross Blue Shield - Michiganprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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