Changes to the medical oncology prior authorization list for URMBT members with Blue Cross non-Medicare plans, starting Feb. 21

For dates of service on or after Feb. 21, 2022, additional drugs will require prior authorization and some drugs will no longer require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans.

Additional drugs to require prior authorization

For dates of service on or after Feb. 21, 2022, we're adding prior authorization requirements for the following drugs covered under the medical benefit for URMBT members with Blue Cross non-Medicare plans:

• Khapzory^™ (levoleucovorin), HCPCS code J0642
• Neupogen^® (filgrastim), HCPCS code J1442

Submit prior authorization requests through AIM Specialty Health^® using one of the following methods:

• Through the AIM ProviderPortal*
• By calling the AIM Contact Center at 1-844-377-1278

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).
• AIM is an independent company that contracts with Blue Cross Blue Shield of Michigan to provide benefit management services.

Drugs that will no longer require prior authorization

For dates of service on or after Feb. 21, 2022, we're removing prior authorization requirements for the following drugs covered under the medical benefit for URMBT members with Blue Cross non-Medicare plans:

• Nivestym^® (filgrastim-aafi), HCPCS code Q5110
• Udenyca^® (pegfilgrastim-cbqv), HCPCS code Q5111
• Ziextenzo^® (pegfilgrastim-bmez), HCPCS code Q5120

More about 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, an independent company that works with the URMBT on specialty pharmacy services, manages prior authorization requests for additional medical benefit drugs.

*Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're not responsible for its content.

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