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Blue Care Network

Request Prescription Drug Coverage

If a medication requires step-therapy or prior authorization, and your BCN patient does not meet our criteria, you can request coverage based on medical necessity. BCN's criteria for coverage are described in the Quality Interchange Program. You can also ask BCN to waive Quantity Limits if the quantity allowed is not appropriate based on the member's condition.


Most BCN members do not have coverage for nonformulary drugs. Generally, BCN will only approve your request for an exception if the alternative drugs included on the plan's formulary would not be as effective and/or would cause the member to have adverse medical effects and if the member meets the established prior authorization criteria for the drug. There are two ways to request coverage:

  • Call the 24/7 Pharmacy Clinical Help Desk at 1-800-437-3803 (select 2 for BCN, BCN Advantage or BlueCaid, then select 1 to initiate a prior authorization request). This is the preferred and most efficient method to generate a medication coverage request. In addition to reducing the potential for fraud, information shared by phone allows a case ID number to generate on the document that will be faxed to the physician and then faxed back to BCN. This facilitates the review process and helps prevent any delay in processing.
  • An alternative process is using the forms available through web-DENIS. After you log in, click on BCN Provider Publications and Resources, then on Forms and scroll down to the Pharmacy section. Fax the completed document to the number identified on the request form. Remember, this alternative process often results in a request to the provider's office for additional information before the coverage request is reviewed.

BCN does not accept requests for coverage that are submitted on forms that have not been approved by BCN.


Please call BCN Pharmacy Services at 248-455-3559 if you suspect fraudulent misrepresentations or use of BCN medication request forms or any other suspicious behavior relating to solicitation of a BCN prior authorization.