By Counterforce Health Team in Keppra (levetiracetam) —

How to Get Keppra (Levetiracetam) Covered by Blue Cross Blue Shield in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Coverage Path

To get Keppra (levetiracetam) covered by Blue Cross Blue Shield of Michigan: First, check your plan's formulary status by calling member services or logging into bcbsm.com. If prior authorization is required, your doctor must submit clinical documentation showing epilepsy diagnosis, seizure frequency, and any failed generic alternatives. For denials, you have 127 days to file an external review with Michigan DIFS. Start today: Contact your prescriber to initiate the prior authorization request and gather your seizure history documentation.

Table of Contents

  1. Coverage Requirements Quick Check
  2. Step-by-Step: Fastest Path to Approval
  3. Medical Necessity Documentation
  4. Common Denial Reasons & Solutions
  5. Michigan Appeals Process
  6. Costs & Financial Assistance
  7. When to Contact Michigan DIFS
  8. Frequently Asked Questions

Coverage Requirements Quick Check

Blue Cross Blue Shield of Michigan maintains several drug formularies that determine Keppra coverage, including the Clinical Drug List, Custom Drug List, and Preferred Drug List. Since branded Keppra is no longer marketed in the U.S., most requests involve generic levetiracetam, which is typically covered but may require prior authorization depending on your specific plan.

Requirement What It Means Where to Find It
Formulary Status Whether levetiracetam is covered BCBS Michigan Drug Lists
Prior Authorization Pre-approval needed before filling Member services or provider portal
Step Therapy Must try other seizure medications first Plan-specific PA criteria
Quantity Limits Restrictions on amount dispensed Formulary documentation
Age Requirements FDA-approved for ages 1 month+ (focal seizures) FDA prescribing information
Note: Coverage varies by specific BCBS Michigan plan. Always verify current requirements through your member portal or by calling the number on your insurance card.

Step-by-Step: Fastest Path to Approval

1. Verify Your Plan's Requirements (Patient - Day 1)

  • Log into your BCBS Michigan member account at bcbsm.com
  • Search for "levetiracetam" in your plan's drug list
  • Note any prior authorization or step therapy requirements
  • Timeline: 15-30 minutes

2. Gather Clinical Documentation (Patient/Provider - Days 1-3)

Your prescriber will need:

  • Current epilepsy diagnosis with ICD-10 codes (e.g., G40.909 for epilepsy)
  • Seizure frequency logs and types
  • Previous antiepileptic drug trials and outcomes
  • Current dosing requirements and monitoring results

3. Submit Prior Authorization (Provider - Days 3-5)

  • Provider submits PA request through BCBS Michigan portal
  • Include medical necessity letter with clinical rationale
  • Attach supporting documentation (seizure logs, prior therapy records)
  • Timeline: 7-14 days for standard review, 72 hours for expedited

4. Follow Up on Decision (Patient/Provider - Days 10-15)

  • Check PA status through provider portal or member services
  • If approved, prescription can be filled
  • If denied, review denial letter for specific reasons

Medical Necessity Documentation

For Keppra coverage approval, your neurologist or prescribing physician should include these key elements in the medical necessity letter:

Essential Clinical Information:

  • Confirmed epilepsy diagnosis with specific seizure type
  • Current seizure frequency and severity
  • Previous antiepileptic medications tried, doses, duration, and outcomes
  • Any contraindications to alternative medications
  • Clinical rationale for levetiracetam specifically

Template Structure for Prescribers:

Patient Information: [Name, DOB, Insurance ID]
Diagnosis: Epilepsy ([ICD-10 code]), [seizure type], frequency [X per week/month]
Prior Treatments: Generic levetiracetam [dose/duration]: [outcome]. [Other AEDs tried]: [results]
Medical Necessity: Levetiracetam is medically necessary due to [specific clinical reasons]. Patient has been stable on this regimen for [duration]. Alternative therapies are contraindicated/ineffective due to [reasons].
Expected Outcome: Continued seizure control with current dosing regimen.
Clinician Corner: When documenting medical necessity, reference specific FDA-approved indications for levetiracetam: adjunctive therapy for focal seizures (ages 1 month+), myoclonic seizures in juvenile myoclonic epilepsy (ages 12+), and primary generalized tonic-clonic seizures (ages 6+). Include any relevant treatment guidelines from the American Academy of Neurology or American Epilepsy Society.

Common Denial Reasons & Solutions

Denial Reason How to Overturn Required Documentation
Generic available Show medical necessity for specific formulation Stability on current brand, breakthrough seizures with generic
Step therapy not completed Document prior AED failures Pharmacy records, clinical notes on failed trials
Not medically necessary Strengthen clinical justification Neurologist letter, seizure logs, treatment history
Quantity limits exceeded Justify dosing requirements Weight-based calculations, therapeutic drug monitoring
Missing documentation Complete PA submission All required forms and clinical records

Michigan Appeals Process

If your Keppra coverage is denied, Michigan's Patient's Right to Independent Review Act provides a structured appeals pathway.

Internal Appeal (First Step)

  • Timeline: File within 180 days of denial
  • Process: Submit through BCBS Michigan member portal or written request
  • Decision: 30 days for standard, 72 hours for expedited
  • Required: Denial letter, additional clinical documentation, appeal letter

External Review with Michigan DIFS

If the internal appeal is denied, you can request an independent external review:

Required Documents for External Review:

  • Completed FIS 0018 form
  • Original denial letter from BCBS Michigan
  • Medical records supporting necessity
  • Physician letter for expedited review (if applicable)
From Our Advocates: We've seen patients successfully overturn Keppra denials by providing detailed seizure logs showing breakthrough seizures when switched to generics, combined with neurologist letters emphasizing the narrow therapeutic index of antiepileptic drugs. The key is thorough documentation of why the specific formulation is medically necessary for seizure control.

Costs & Financial Assistance

While generic levetiracetam is typically affordable (often under $20 for a 60-tablet supply), patients may still face coverage challenges or copay concerns.

Financial Resources:

  • Manufacturer Support: Contact UCB (original Keppra manufacturer) patient assistance programs
  • State Programs: Michigan Medicaid expansion ("Healthy Michigan") may provide coverage options
  • Pharmacy Programs: GoodRx and similar discount programs for cash-pay options
  • Foundation Assistance: Epilepsy Foundation may have medication assistance programs

When to Contact Michigan DIFS

Contact the Michigan Department of Insurance and Financial Services if:

  • Your internal appeal has been denied and you need external review
  • BCBS Michigan fails to respond within required timeframes
  • You need assistance understanding your appeal rights
  • You believe the denial violates Michigan insurance law

Michigan DIFS Contact Information:

Frequently Asked Questions

How long does BCBS Michigan prior authorization take for Keppra? Standard prior authorization decisions are made within 7-14 days. Expedited reviews (when medically urgent) are completed within 72 hours.

What if levetiracetam is not on my formulary? You can request a formulary exception through the prior authorization process. Your doctor must demonstrate medical necessity and why formulary alternatives are inappropriate.

Can I get an expedited appeal for seizure medication? Yes, if delaying treatment would seriously jeopardize your health. Your physician must provide a letter stating that delay would be harmful, and DIFS will complete expedited external reviews within 72 hours.

Does step therapy apply if I was stable on Keppra before switching to BCBS Michigan? Provide documentation of your treatment history and stability on levetiracetam. Plans may waive step therapy requirements when there's evidence of successful treatment.

What if I need brand-name Keppra specifically? Since branded Keppra is no longer available in the U.S., focus on demonstrating medical necessity for the specific generic formulation that has kept your seizures controlled.

How much does the external review process cost? External reviews through Michigan DIFS are free for patients. There are no filing fees for requesting independent review.

About Counterforce Health: Counterforce Health helps patients, clinicians, and specialty pharmacies navigate insurance denials by creating targeted, evidence-backed appeals. The platform analyzes denial letters and plan policies to draft point-by-point rebuttals aligned with payer requirements, pulling the right clinical evidence and regulatory citations to support coverage requests.

For additional support with your Keppra coverage appeal, Counterforce Health can help identify the specific denial reasons and develop a comprehensive response strategy tailored to your Blue Cross Blue Shield Michigan plan requirements.

Sources & Further Reading

Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Coverage policies and appeal procedures may change. Always consult with your healthcare provider about treatment decisions and verify current insurance requirements with your plan administrator. For legal assistance with insurance appeals, consider consulting with a qualified attorney familiar with Michigan insurance law.

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