Additional drugs require prior authorization for Blue Cross URMBT non-Medicare members, starting Nov. 1
For dates of service on or after Nov. 1, 2021, we're adding prior authorization requirements for the following drugs covered under the medical benefit:
- Abecma® (idecabtagene vicleucel), HCPCS code J3590
- Breyanzi® (lisocabtagene maraleucel), HCPCS codes J3590, C9076
- Beovu® (brolucizumab-dbll), HCPCS code J0179
- Tepezza® (teprotumumab-trbw), HCPCS code J3241
- Onpattro® (patisiran), HCPCS code J0222
Submit prior authorization requests through the NovoLogix® online tool.
Prior authorization requirements apply when these drugs are administered in an outpatient setting for Blue Cross UAW Retiree Medical Benefits Trust, or URMBT, non-Medicare members.
How to submit authorization requests
Submit prior authorization requests through NovoLogix. It offers real-time status checks and immediate approvals for certain medications.
To learn how to submit requests through NovoLogix, do the following:
- Click the Blue Cross link on this website.
- Click Medical Benefit Drugs.
- Scroll to the Blue Cross commercial column.
- Review the information in the “How to submit requests electronically using NovoLogix” section.
More about the authorization requirements
Authorization isn't a guarantee of payment. As always, health care practitioners need to verify eligibility and benefits for members.
For additional information on requirements related to drugs covered under the medical benefit for Blue Cross URMBT non-Medicare members, see:
- Medical Drug Management with Blue Cross for UAW Retiree Medical Benefit Trust PPO non-Medicare Members (PDF)
- Medical oncology prior authorization list for UAW Retiree Medical Benefits Trust PPO non-Medicare members (PDF)
Note: Accredo manages prior authorization requests for additional medical benefit drugs.
We'll update the appropriate drug lists to reflect the information in this message prior to the effective date.
Posted: August 2021
Line of business: Blue Cross Blue Shield of Michigan