Medical specialty drug prior authorization lists are changing in September for BCN HMO^SM, Medicare Plus Blue^SM PPO and BCN Advantage^SM members

We're adding authorization requirements for three specialty drugs covered under the medical benefit for BCN HMO, Medicare Plus Blue and BCN Advantage members.

For dates of service on or after Sept. 25, 2020, the following drugs will require authorization through AIM Specialty Health^®:

• Zepzelca^™ (lurbinectedin), HCPCS codes J3490, J3590, J9999
• Phesgo^™ (pertuzumab/trastuzumab/hyaluronidase-zzxf), HCPCS codes J3490, J3590, J9999
• Nyvepria^™ (pegfilgrastim-apgf), HCPCS codes J3490, J3590, J9999

How to submit authorization requests

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 website.

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:

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

We'll update these lists with the new information about these drugs prior to the effective dates.

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