Viltepso^™ will require authorization for commercial members effective September and October 2020

We're adding authorization requirements for Viltepso (viltolarsen), HCPCS code J3490, a medical benefit specialty drug, for the following members:

• For BCN HMO^SM members: Viltepso will require authorization for members who begin therapy on or after Sept. 1, 2020.
• For Blue Cross' PPO members: Viltepso will require authorization for members who begin therapy on or after Oct. 1, 2020.

Blue Cross Blue Shield of Michigan and Blue Care Network consider Viltepso to be investigational/experimental due to insufficient evidence of clinical benefit. We'll continue to consider this drug to be investigational/experimental until the results of clinical trials provide evidence of clinical benefit.

How to submit authorization requests

Submit authorization requests through NovoLogix. It offers real-time status checks and immediate approvals for certain medications.

To learn how to submit requests through NovoLogix, do the following from within this website:

• For BCN HMO members: Click BCN and then click Medical Benefit Drugs. In the BCN HMO (commercial) column, see the "How to submit authorization requests electronically using NovoLogix" section.
• For Blue Cross' PPO members: Click Blue Cross and then click Medical Benefit Drugs. In the Blue Cross PPO (commercial) column, see the "How to submit authorization requests electronically using NovoLogix" section.

More about the authorization requirements

These authorization requirements apply only to groups that currently participate in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. These changes don't apply to members covered by the Federal Employee Program^® Service Benefit Plan.

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

List of requirements

For a list of requirements related to drugs covered under the medical benefit, please see the Blue Cross and BCN utilization management medical drug list for Blue Cross PPO (commercial) and BCN HMO (commercial) members (PDF) document, which is available from these pages of this website:

• Blue Cross Medical Benefit Drugs - Pharmacy
• BCN Medical Benefit Drugs - Pharmacy

We'll update the requirements list with this information prior to each effective date.