Michigan Medicaid Health Plan Management of Drug Therapies
Effective January 1, 2020, Michigan Department of Health and Human Services (MDHHS) will be carving in many drugs that are dispensed at the pharmacy that are currently carved out.
Health plans are required to extend coverage through March 31, 2020, so that the member has enough time to obtain a PA without interruption in their drug therapy. In addition, prior authorizations previously approved through fee-for-service will be honored through their original approval expiration date.
As a note, the following drugs, which are part of specific MDHHS program initiatives, will continue to be carved out:
- Drugs to treat substance use disorder
- Hepatitis C direct-acting antivirals
- HIV medicines
- Organ replacement therapy
However, specific classes will be carved in, such as medications used in the treatment of enzyme deficiencies, cystic fibrosis, certain antineoplastic agents and factors for hemophilia.
Details regarding the changes will be posted on the Medicaid Health Plan (MHP) Common Formulary website in the near future.
Information specific to Blue Cross Complete is listed below:
- Prior authorization requests for these medications will need to be submitted to Blue Cross Complete.
- To request a prior authorization, providers can complete the Blue Cross Complete Medication Prior Authorization Request form or submit a prior authorization request online mibluecrosscomplete.com using the self-service tab under the provider menu.
If you have any questions, please contact your Blue Cross Complete provider account executive, Blue Cross Complete Provider Inquiry at 1-888-312-5713 or the Blue Cross Complete pharmacy helpdesk at 1-888-288-3231.