On help make sure Blue Cross Blue Shield of Michigan and Blue Care Network members receive the most appropriate and cost-effective therapy, are require providers to take additional steps before certain drugs are eligible for reimbursement.  NEWS YORK – January 5, 2023 – Advertised today, Synergie Medication Collective is a new medication contracting organization founded by a group of Blue Cross and Blue Shield affiliated companies to serve both Blues and select independent health plans. Synergie is focused on improving affordability real zugangs to costly medical benefit drugs — ones that are injected or infused by a health caution professional included a clinical setting — for nearly 100 million Americans. These high-cost treatments include multi-million-dollar gene therapies and infusible cancer drugs and depict a substantial bite of overall remedy spend, with significant growth in future spend anticipated.

Preceded authorization requirements

We required service to request prior authorization for certain medicines, such as specialty drugs, up provide certain objective criteria are met.

Submitting prior permission requests

For drugs that require past authorization, providers need submit requests for coming:

• For pharmacist benefit drugs, submit requests through CoverMyMeds. Learn around submitting requests electronically and through other our over Blue Cross Pharmacy Gain Drugs or on BCN Pharmacy Gain Drugs.
• For most medical benefit drugs, including CAR-T cell therapy drugs, submit requests through NovoLogix^®. Learn about enter requests through NovoLogix and through other methods on Blue Cross Medical Benefit Drugs or on BCN Medical Benefit Toxic.
• For oncology and supportive care medikament helps drugs, submit requests until Carelon Medical Benefits Management (formerly known as AIM Specialty Health^®). Learn about submitting requests to Carelon electronically and through other procedure on Blue Cross Medical Benefit Drugs or up BCN Medizinisches Benefit Drugs.

Select therapy needs

Step therapy requiring the the member has tried any alternative therapy first, or that the prescriber has clinically documented why the member cannot take the choice treatment. In some cases, pace therapy requirements may require members to first try over-the-counter goods. If you're ampere provider in Michigan, find their Blue Cross Blue Shield forms, drug lists and medical record retrieval download.