Pharmacy Benefits

Blue Cross Complete of Michigan members are eligible for pharmacy benefits. You can use your benefits to fill prescription and over-the-counter medicines at a pharmacy in our network.

Finding a pharmacy

You can find a list of pharmacies near you on our Find a Pharmacy page. You can also see a copy of our pharmacy network by clicking here: Printable Pharmacy Network (PDF). If you’d like a hard copy mailed to you, call Pharmacy Customer Service at 1-888-288-3231. TTY users should call 1-888-988-0071.

More information about your pharmacy benefits can be found in your handbook (PDF).

Using your ID card for prescriptions

Show your member ID card to your pharmacy. This will help you get your prescription coverage.

Ask your pharmacy to call PerformRx Pharmacy Provider Services at 1-888-989-0057. They will help your pharmacy get the billing information they need.

Call Blue Cross Complete's Customer Service at 1-800-228-8554, 24 hours a day, seven days a week. TTY users should call 1-888-987-5832.

Prescriptions

Your doctor may prescribe medicines when you need them. We cover medicines that are:

  • Prescribed by a licensed health care professional
  • Medically necessary
  • Approved by the Food and Drug Administration
  • Not excluded by the Michigan Medicaid program 

We cover some over-the-counter medicines and products. You must have a prescription from your doctor. Some medicines we cover are:

  • Sinus and allergy medicines
  • Medicines to help you quit smoking
  • Pain medicine, such as acetaminophen, naproxen and ibuprofen
  • Heartburn medicine, including antacids and famotidine

We cover diabetic monitoring and testing supplies:

Preferred drug list

The Preferred Drug List, known as the drug formulary, is the list of medicines we cover. This list can help your doctor select medicines for you. Both generic and brand name medicines are on the list. We require the generic medicines be used when available.

Copays

We cover the medicines on our Preferred Drug List (PDF). You won't have a copay for these medicines. Always show your member ID card at the pharmacy.

Note: Healthy Michigan Plan members won’t have a copay at the pharmacy. You may have a charge on your MI Health account.

Opioids

Opioids are a class of drugs that include pain medicines available from a doctor. Drugs, such as morphine, codeine and oxycodone are common opioids used to treat pain. Others include the synthetic opioid, fentanyl, and the illegal drug, heroin. If misused or not taken as prescribed, all opioids are able to cause addiction or death.

If you are prescribed opioids
Work with your doctor to make a plan for your treatment and discuss the risks of taking opioids. If possible, a nonopioid treatment may be used. Take your medicines exactly as prescribed — never in larger or more frequent doses. Store your opioids in a safe, secure place that isn’t accessible to children, family or visitors. If you have unused medicine, dispose of it properly by requesting a medicine disposal bag from Blue Cross Complete, or finding a collection site near your home.

When opioids become a problem
Opioid use disorder happens when someone becomes dependent on a drug and it interferes with his or her daily life. He or she may take too much of a prescription or turn to an illegal alternative. It can happen to anyone. If you or someone you know needs help, call the Substance Abuse Hotline at 1-800-662-HELP (4357). You can also explore resources and other materials on the Michigan Opioid Resources webpage or through MI Blues Perspective.

If you or a loved one are at risk of an opioid overdose, you may want to carry naloxone, a medication that can reverse an overdose. You can get naloxone from a registered pharmacy without a prescription. MDHHS has a map of pharmacies approved to provide naloxone.

If you can’t get naloxone locally, you can ask to have it mailed to you. To qualify, you’ll be asked to watch a training video, answer a quiz and provide enrollment information. Visit NEXT Naloxone to learn more.

If you suspect someone is overdosing, call 911 immediately.

If you need to talk to a loved one about their opioid use
MDHHS has resources for approaching a loved one whose behavior indicates they may be using opioids. The information includes a helpful guide about talking to your loved one with healing language.

Medicine disposal bags available for members

Do you have old or unused medicine lying around? It’s important to get rid of it safely. Blue Cross Complete can help you do that. We provide free medicine disposal bags to members. You can use these bags to get rid of your old medicine. It’s good for the environment and protects your household from any misuse.

  1. Visit the Contact Us page.
  2. Once there, click on the Secure Email Form.
  3. Fill out the form.
  4. For the subject box, select Member-Medicine Disposal Bags as your topic. Choose the quantity of bags you'd like to order.

It may take up to 10 business days for you to receive your order. If you have questions, call Customer Service at 1-800-228-8554, 24 hours a day, seven days a week. TTY users should call 1-888-987-5832.

National Prescription Drug Take Back Day

National Prescription Drug Take Back Days occur in October and April each year. These events provide a safe and easy way to get rid of medicines you no longer need. To find disposal locations near you, use this helpful search tool.

For more information, visit takebackday.dea.gov.

Carve-out medicines

Some medicines are covered by the state of Michigan and not by Blue Cross Complete. These medicines are called “carve-outs.” The carve-out list (PDF) includes medicines used for HIV, hepatitis C, cystic fibrosis, seizure disorders, sleep problems and some behavioral health issues. The pharmacy will need your MIHealth card or your Medicaid ID number to process carve-outs.

Members 21 and older will pay a small fee for carve-outs. The copay is $1 for generic medicines and $3 for brand-name medicines.

Drug shortages

The U.S. Food and Drug Administration keeps track of drug shortages. Drug shortages can occur because of manufacturing and quality problems, delays and discontinuations. Manufacturers provide the FDA with many drug shortage concerns. Visit the FDA online for more information.

Drug recalls

The FDA keeps track of drug recalls and safety alerts. Below is a list of recalls.

Prior authorization

Some medicines require prior authorization by Blue Cross Complete. Your doctor will need to submit a prior authorization request using one of the following forms:

Your doctor must submit a request for a prior authorization for you. They must also submit an override of a drug restriction. Requests from pharmacists aren’t accepted.

Prior authorization process

Once we receive a request, we’ll review the information. After a decision has been made, you’ll receive a letter with the approval or denial. If it’s denied, we’ll let you know why. Your doctor will receive a letter or a fax with the same information.

We will cover the medicine if it’s medically necessary. If we don’t believe it’s medically necessary, we’ll send you a letter that tells you why. If you or your doctor disagree with our decision, you can appeal it.

Formulary medicines are preferred. If a non-formulary medicine is prescribed, we may require you to try the available formulary medicines first. If it doesn't work, or your doctor doesn’t think they’re appropriate for you, they can submit a prior authorization request for a non-formulary medicine.

If more assistance is needed, your doctor can call PerformRx Pharmacy Provider Services at 1-888-989-0057. Your doctor can fax a hard copy of the form to 1-855-811-9326.

Appeal of prior authorization denials

Your doctor, with your written approval, may ask us to review a prior authorization request that we denied:

 

Write to
Member Appeals
Blue Cross Complete of Michigan
P.O. Box 41789
North Charleston, SC 29423

 

Fax to
1-866-900-4482

Pharmacy prior authorization – emergency supply

A doctor might not get prior authorization. In some cases, you can work with your pharmacy to get an emergency supply of the medicine for three days. If we don't have enough information to make a decision, we'll ask for more information. All clinical information requests must be completed within 24 hours of this request.

Doctors may also ask for copies of the information that was used to make the prior authorization decision. They can contact PerformRx Pharmacy Provider Services at 1-888-989-0057.

Specialty medicines

All specialty medicines, such as those for complex diseases, require prior authorization. The Prior Authorization Request (PDF) form must be completed. The form should be submitted by following the steps on the form.