Medicare Part B medical specialty drug prior authorization list is changing in July and August

We're making changes to the Medical Drug and Step Therapy Prior Authorization List for Medicare Plus BlueSM PPO and BCN AdvantageSM members. The specialty medications on this list are administered by a healthcare professional in a provider office, at the member's home, in an off-campus outpatient hospital or in an ambulatory surgical center (sites of care 11, 12, 19, 22 and 24).

New authorization requirement

For dates of service on or after July 9, 2020, the following medication for wet age-related macular degeneration will require authorization through the NovoLogix® online tool:

Authorization requirement removed

For dates of service on or after Aug. 1, 2020, the following medications for osteoporosis and other diagnoses involving bone health will no longer require authorization:

How to bill

For Medicare Plus Blue and BCN Advantage, we require authorization for all outpatient sites of care when you bill these medications as a professional service or as an outpatient facility service:

Important reminder

Submit authorization requests through NovoLogix. It offers real-time status checks and immediate approvals for certain medications. For Medicare Plus Blue and BCN Advantage, if you have access to Provider Secured Services, you already have access to enter authorization requests through NovoLogix.

If you need to request access to Provider Secured Services, complete the Provider Secured Access Application form and fax it to the number on the form.

List of requirements

For a list of requirements related to drugs covered under the medical benefit, please see the Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue PPO and BCN Advantage members.

Posted: June 2020
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network