BCN requires authorization for additional drugs starting Jan. 1, 2017
Starting Jan. 1, 2017, Blue Care Network requires authorization as shown below for the following drugs covered under the medical benefit:
| Drug name | Procedure code | Authorization required for BCN HMOSM (commercial) members? | Authorization required for BCN AdvantageSM members? |
|---|---|---|---|
| Cinqair® | J2786 | Yes | Yes |
| Darzalex™ | J9145 | Yes | No |
| Empliciti™ | J9176 | Yes | No |
| Kanuma™ | J2840 | Yes | Yes |
| Nucala® | J2182 | Yes | Yes |
| Onivyde™ | J9205 | Yes | No |
| Portrazza™ | J9295 | Yes | No |
| Probuphine® | J0570 | Yes | No |
| Yondelis® | J9352 | Yes | No |
You must submit authorization requests for these drugs using the NovoLogix web tool and must include the following clinical information to support the authorization request:
- Diagnosis
- Lab results
- Names of medications previously used to treat the member's condition, including dose, regimens, dates of therapy and response
You may also be required to submit additional pertinent clinical information and documentation related to the specialty of the prescribing physician and the member's age.
These drugs currently require authorization because they were assigned not-otherwise-specified procedure codes. Starting Jan. 1, these drugs require authorization under the new codes they are assigned.
Information about using the NovoLogix web tool is available on the Medical Benefit Drugs – Pharmacy web page on this website.
Posted: November 2016
Line of business: Blue Care Network