Effective Oct. 1, Nivestym^® and Zarxio^® are the preferred filgrastim products for all Blue Cross and BCN commercial and Medicare Advantage members

For dates of service on or after Oct. 1, 2020, the preferred filgrastim products for all Blue Cross and Blue Care Network commercial and Medicare Advantage members will be:

• Nivestym (filgrastim-aafi; HCPCS code Q5110)
• Zarxio (filgrastim-sndz; HCPCS code Q5101)

Note: For commercial members, the requirements outlined in this message apply only to groups that are currently participating in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. They don't apply to non-Medicare members covered through the UAW Retiree Medical Benefits Trust. They also don't apply to members covered by the Federal Employee Program^® Service Benefit Plan.

Patients should take the preferred drugs when possible

Here's what to keep in mind about the members who are prescribed these drugs:

• Members starting treatment on or after Oct. 1 should use a preferred filgrastim product.
• Members currently receiving a filgrastim product other than Nivestym or Zarxio should transition to Nivestym or Zarxio.

  The filgrastim products other than Nivestym and Zarxio are:

  • Neupogen^® (filgrastim; HCPCS code J1442)
  • Granix^® (tbo-filgrastim; HCPCS code J1447)
    
    For commercial members, we'll notify those currently taking the nonpreferred drugs and encourage them to discuss treatment options with you.

Here are the authorization requirements for members starting or transitioning to the preferred drugs:

• For Blue Cross' PPO members, the preferred drugs don't require authorization.
• For BCN HMO^SM, Medicare Plus Blue^SM PPO and BCN Advantage^SM members, the preferred drugs require authorization through AIM Specialty Health^®.

Request authorization for patients who must take the nonpreferred drugs

For members you feel need to take Neupogen or Granix rather than Nivestym and Zarxio, here are the requirements:

• For Blue Cross’ PPO members, authorization is required. Submit the authorization request through the NovoLogix^® online tool.
• For BCN HMO, Medicare Plus Blue and BCN Advantage members, both step therapy and authorization are required. Submit the authorization request through AIM Specialty Health^®.

More about the authorization requirements

Authorization isn't a guarantee of payment. Health care practitioners need to verify eligibility and benefits for members.

For additional information on requirements related to drugs covered under the medical benefit, see:

• Blue Cross' PPO and BCN HMO: Blue Cross and BCN utilization management medical drug list (PDF)
• Medicare Advantage: Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue PPO and BCN Advantage members (PDF)

We'll update the requirements lists with the new information prior to Oct. 1, 2020.