Recommendations for submitting authorization requests for medical oncology drugs to AIM

Here are some recommendations to follow when submitting authorization requests for medical oncology drugs to AIM Specialty Health^®:

• Wait to submit the request until you have all the pertinent information, including but not limited to tumor testing results and information on tumor staging and prior therapy regimens.
• Provide all the clinical information needed for clinical review, including the rationale for the requested regimen.
• Ensure that the phone number you provide is an accurate one, so AIM can contact you to schedule a peer-to-peer consultation if they need more information to establish medical necessity.

When you follow these guidelines, the process of reviewing authorization requests goes more smoothly and takes less time.

The information in this message applies to all members whose plans require authorization of medical oncology drugs by AIM:

• Medicare Advantage plans: Medicare Plus Blue^SM PPO and BCN Advantage^SM
• Commercial plans: BCN HMO^SM and select Blue Cross' PPO groups

How to submit authorization requests

For medical oncology drugs, submit authorization requests to AIM using one of the following methods:

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

For information about registering for and accessing the AIM ProviderPortal, see the Frequently asked questions page on the AIM Specialty Health website.*

Lists of requirements

To see the requirements related to drugs covered under the medical benefit, including medical oncology drugs, refer to:

• For Medicare Advantage members: Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue PPO and BCN Advantage members (PDF)
• For commercial members:
  • Medical oncology prior authorization list for Blue Cross' PPO UAW Retiree Medical Benefits Trust members (PDF)
  • Medical oncology prior authorization list for BCN HMO (commercial) members (PDF)

The specialty medications on these lists are administered in outpatient sites of care, including a physician's office, an outpatient facility or a member's home.

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