Additional drugs require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans, starting Jan. 3
For dates of service on or after Jan 3, 2022, we're adding prior authorization requirements for the following drugs covered under the medical benefit for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans:
- Enhertu® (fam-trastuzumab deruxtecan-nxki), HCPCS code J9358
- Jelmyto® (mitomycin), HCPCS code J9281
- Lumoxiti® (moxetumomab pasudotox-tdfk), HCPCS code J9313
- Padcev® (enfortumab vedotin-ejfv), HCPCS code J9177
- Phesgo™ (pertuzumab, trastuzumab and hyaluronidase–zzxf), HCPCS code J9316
- Sarclisa® (isatuximab-irfc), HCPCS code J9227
- Zepzelca™ (lurbinectedin), HCPCS code J9223
Submit prior authorization requests through AIM Specialty Health®.
Notes:
- Prior authorization requirements apply when these drugs are administered in an outpatient setting.
- This requirement doesn't apply to the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714).
How to submit authorization requests
Submit prior authorization requests to AIM using one of the following methods:
- Through the AIM ProviderPortal*
- By calling the AIM Contact Center at 1-844-377-1278
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 oncology prior authorization list for UAW Retiree Medical Benefits Trust PPO non-Medicare members (PDF)
- Medical Drug Management with Blue Cross for UAW Retiree Medical Benefit 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.
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Posted: October 2021
Line of business: Blue Cross Blue Shield of Michigan