Nulibry to require authorization for commercial members

Blue Cross Blue Shield of Michigan and Blue Care Network are adding a prior authorization requirement for Nulibry (fosdenopterin), HCPCS codes J3490 and J3590, as follows:

How to submit authorization requests

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

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

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.

To determine whether a group participates in the prior authorization program, see the Specialty Pharmacy Prior Authorization Master Opt-in/out Group list.

Note: The Blue Cross and Blue Shield Federal Employee Program® and the UAW Retiree Medical Benefits Trust (non-Medicare) don't participate in the standard prior authorization program.

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 document, which is available from these pages of this website:

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

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