Starting Dec. 27, additional drugs require prior authorization for URMBT members with Blue Cross non-Medicare plans

For dates of service on or after Dec. 27, 2021, we're adding requirements for the following drugs covered under the medical benefit:

• Nulibry^™ (fosdenopterin), HCPCS code J3590, will have a prior authorization requirement.
• Avsola^™ (infliximab-axxq), HCPCS code Q5121, will have both prior authorization and site-of-care requirements.
• Lemtrada^® (alemtuzumab), HCPCS code J0202, already requires prior authorization. We're adding a site-of-care requirement.
• Tysabri^® (natalizumab), HCPCS code J2323, already requires prior authorization. We're adding a site-of-care requirement.

These requirements apply when the drugs are administered in an outpatient setting for Blue Cross UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans.

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, visit the Blue Cross Medical Benefit Drugs page on the ereferals.bcbsm.com website. Scroll to the Blue Cross commercial column and review the information in the “How to submit authorization 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 UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans, 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)

We'll update the appropriate drug lists to reflect the information in this message prior to the effective date.

Note: Accredo manages prior authorization requests for additional medical benefit drugs.

Posted: September 2021
Line of business: Blue Cross Blue Shield of Michigan