Prior Authorization

We have a team of doctors and pharmacists who help us create tools so we can offer good benefits to our members. Some of the tools are listed and described below:

  • Prior Authorization: We require you to get for approval from us for certain drugs. We call this Prior Authorization. You may need a drug that is not on the List of Drugs. To get this drug covered you will need to get approval. If you don’t get approval, you may be asked to pay for the drug.
  • Age Limits: Some drugs require approval if your age does not meet what is advised by the Food and Drug Administration (FDA) or medical recommendations.
  • Quantity Limits: Some drugs limit the number of pills for a specific number of days.
  • Step Therapy:  Some drugs require a less expensive drug before “stepping up” to drugs that cost more.

You can ask to make an exception to our coverage rules.

Refer to the List of Drugs for the types of exceptions you can ask us to make.

For utilization restriction exceptions the doctor should submit a note supporting the reason for the exception with a completed Coverage Determination form.

We must decide within 72 hours of getting the note and form from your doctor.

You or your doctor can request an expedited (fast) exception if your health is in danger.  If an expedited exception is allowed, we must decide within 24 hours of getting the note and form from your doctor. 

Prior Authorization Form*
Prior Authorization Criteria
Quantity Limit Listing
Step Therapy Criteria

* Please note – This form cannot be used for non-covered drugs, fertility drugs, drugs for weight loss, weight gain or hair growth.

Please call Michigan Complete Health (MMP) at 1-844-239-7387. Hours are from 8 a.m. to 8 p.m., seven days a week. TTY users call 711. On weekends and on state or federal holidays, you may be asked to leave a message. Your call will be returned within the next business day.

Last Updated: 06/09/2017