Additional medications will require prior authorization for most members starting May 24

For dates of service on or after May 24, 2021, we're adding prior authorization requirements for the following drugs covered under the medical benefit:

• Cosela^™ (trilaciclib), HCPCS codes J3490, J3590, J9999, C9399
• Pepaxto^® (melphalan flufenamide), HCPCS codes J3490, J3590, J9999, C9399

The prior authorization requirements apply when these drugs are administered in outpatient settings for:

• Members covered through Blue Cross commercial fully insured groups except Michigan Education Special Services Association members
• Blue Cross commercial members with individual coverage
• Medicare Plus Blue^SM members
• BCN commercial members
• BCN Advantage^SM members

These requirements don't apply to Blue Cross commercial self-funded groups, including:

• Blue Cross and Blue Shield Federal Employee Program^® members
• UAW Retiree Medical Benefits Trust non-Medicare members
• All other Blue Cross commercial self-funded groups

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 the following documents:

• For commercial members, see:
  • Standard commercial medical drug program: Blue Cross and BCN utilization management medical drug list for Blue Cross PPO (commercial) and BCN HMO (commercial) members document (PDF)
  • Medical oncology drug program: Medical oncology prior authorization list for Blue Cross PPO' (commercial) fully insured and BCN HMO (commercial) members (PDF)
• For Medicare Advantage members, see the 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 May 24, 2021.

*Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're not responsible for its content.

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