Additional medications will require prior authorization for Medicare Advantage members, starting June 22

For dates of service on or after June 22, 2021, the following medications will require prior authorization through the NovoLogix^® online tool:

• Oxlumo^™ (lumasiran), HCPCS code C9074
• Evkeeza^™ (evinacumab-dgnb), HCPCS codes C9399, J3490, J3590
• Nulibry^™ (fosdenopterin), HCPCS codes C9399, J3490, J3590

This change will affect Medicare Plus Blue^SM and BCN Advantage^SM members.

To learn more about this change, see the detailed provider alert.

Posted: March 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network