Many insurance companies post information about their step therapy policies online. You can often also find information about what medications your insurance company will cover and which drugs will require step therapy. When possible, it’s a good idea to share the links or printed copies of the drug lists with your doctor.
If your plan requires step therapy for a medicine you and your doctor know you need, you may have to follow the insurance company’s grievance or appeals process. Each plan is different, but in almost all cases you’ll need to file a form with your insurance company and/or write a letter. Some insurance companies may require you to upload letters and forms on their website.
Helpful links to online resources and information are below.
Click the button below to access letter templates for you and your doctor.
Blue Cross Blue Shield of Michigan:
(including Blue Care Network plans and Medicare plans)
BCBS posts information about their step therapy policies on this page. The page includes instructions for logging into your account online and finding out if a prescription will require step therapy. In some cases, a “coverage review” may be required. Your doctor can call BCBS for a review at 1-800-437-3803.
You can also view which medications are covered online by accessing BCBS drug lists. Links to the lists – sorted by the type of plan you have – are available on this page.
If you have a BlueCare Network Advantage plan, here is the list of drugs for which step therapy will be required. If you have a Medicare plan with BCBS, you may need to request an exception to how a medicine is covered – information on how to do that is on this page.
Grievance and Appeals
- If you have a PPO or EPO plan, a good overview of the process, and resources available to you depending on your type of plan, is on this page. Here is the appeal form for members.
- If you have an HMO plan, you’ll want to start at this page. HMO plans require you to first file a grievance, then an appeal - if the grievance is not resolved to your satisfaction . Details about how the process works and how long it takes are on the page.
- Start with this page if you have a Medicare plan.
- You can also find a list of contacts for grievances and appeals for various BCBS plans.
Appeals Department Address: Blue Cross Blue Shield of Michigan, Pharmacy Services, P.O. Box 2320, Detroit, MI 48231-2320
Customer Service Number: 1-800-437-3803
Priority Health members can log in to learn more about their prescription drug coverage on this page. You can also search for a drug online to see if it is covered and/or if step therapy will be required on this page. Or, you can print lists of covered drugs (including ones for which step therapy is required), by your type of plan, from this page.
Grievance and Appeals
A list of customer service phone numbers by type of plan is on this page. Priority Health posts details about their appeals processes, including information about where to send appeal requests online. You can find information for various plan types at these links:
Appeals Department Address: Priority Health Appeal Coordinator, MS 1145 PO Box 269, Grand Rapids, MI 49501-0269
Customer Service Number: 1-800-942-0954
Molina posts information about which prescription drugs are covered, by type of plan, online at this page. (Note your plan may require you to have prescriptions filled through a pharmacy in the Molina Healthcare Pharmacy Network). The 2017 formulary for individual plans is here, You can request an exception for medications not listed on the drug list with this form, and fax it to 866-504-7249.
If you have a Molina Medicare plan, information about covered drugs can be found on this page.
Grievance and Appeals
Information about Molina’s grievance and appeals process, including appeal forms, how long responses will take, phone numbers and addresses is posted online.
Appeals Department Address: Molina Healthcare, Grievance and Appeals Unit, 880 West Long Lake RoadTroy, MI 48098
Customer Service Number: 1-888-560-4087
Health Alliance Plan (HAP)
HAP posts information about their prescription drug plans and coverage on this page. This includes information about how HAP uses step therapy at the bottom of the page.
If you have a HAP Medicare plan, you can find the current drug formulary here. If you have an employer-provided HAP plan, the current drug list is here. And if you have an individual or small-group HAP plan, the current drug list is here.
HAP also posts information about its specialty drug process and list online. HAP requires prior authorization for drugs on this list and a special process for dispensing the medication. You can also find a customer service number for Pharmacy Advantage – which manages the specialty drug program for HAP on the page.
Grievance and Appeals:
The primary toll-free number for HAP customer service is 1-800-422-4641. You can also find additional phone numbers, an address for sending communication by mail, and addresses of customer service centers on this page. You may also be able to log-in to your account to request customer service, a good starting point is the member resources page.
For HAP individual or small-group plans, you may be able to fill out a form online to request an exception at https://portal.hap.org/providers/mrf.php . You can request drug exceptions by mail or fax.
If you have a HAP Medicare plan, information about the appeals process, including contact information and links to forms you can fill out online is on this page.
Appeals Department Address: Health Alliance Plan, ATTN: Appeal and Grievance Department 2850 W. Grand Blvd. Detroit, MI 48202
Customer Service Number: 1-800-422-4641
Some limited information about how Meridian uses step therapy and its prescription drug processes are available on the FAQ page (scroll down to the pharmacy section). Meridian posts its list of drugs for which it requires step therapy online. You can also view the entire 2017 formulary here. The drug list for Meridian Medicaid plans is also available.
Grievances and Appeals
Meridian posts information about how to file grievances and appeals, including details about how the process works in its members guide. You can find grievance and appeals information beginning on page 21 in the 2017 guide available online. If you have a MeridianComplete plan (Medicare-Medicaid), details on the grievance and appeal process is here.
Appeals Department Address: Meridian Essential - Appeals Coordinator, 1 Campus Martius, Suite 700
Detroit, MI 48226
Customer Service Number: 1-888-437-0606