Abecma® to require prior authorization for commercial members starting April and May

Abecma (idecabtagene vicleucel), HCPCS code J9999, will require prior authorization through the NovoLogix® online tool for the following members:

Some Blue Cross groups not subject to these requirements

For Blue Cross commercial members, 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 (PDF).

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

How to submit authorization requests

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

Providers can learn how to submit requests through NovoLogix as follows:

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. There are links to this document on the Medical Benefit Drug pages of this website.

We'll update this list with these new requirements prior to the effective dates.

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

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