Empaveli® and Actemra® to require prior authorization for Blue Cross URMBT non-Medicare members, starting June 1

For dates of service on or after June 1, 2022, we’re adding prior authorization requirements for the following drugs covered under the medical benefit:

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.

Important: For members with claims showing use of these drugs prior to June 1, we'll automatically authorize the drugs for dates of service through Nov. 30, 2022, to provide continuity of care. You'll need to request authorization for dates of service on or after Dec. 1, 2022.

Note: This new authorization 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 using the NovoLogix® tool. It offers real-time status checks and immediate approvals for certain medications.

To learn how to submit requests using the NovoLogix tool, do the following:

  1. Go to ereferrals.bcbsm.com.
  2. Click Blue Cross.
  3. Click Medical Benefit Drugs.
  4. Scroll to the Blue Cross commercial column.
  5. 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 Blue Cross URMBT non-Medicare members, see:

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: March 2022
Line of business: Blue Cross Blue Shield of Michigan