For Medicare Advantage inpatient admissions, submit prior authorization requests for CAR-T cell therapy drugs to NovoLogix

Before you begin administering CAR-T cell therapy drugs for Medicare Plus Blue^SM or BCN Advantage^SM members in an inpatient setting, you must do the following:

• Submit the request for the CAR-T cell therapy drug, including all relevant clinical documentation, as follows:
  • Through the NovoLogix^® online tool. (See the "NovoLogix" section below for more information.)
  • By sending a fax to the Pharmacy Part B help desk at 1-866-392-6465
• Submit a separate request for the inpatient admission and other inpatient services (not including the CAR-T cell therapy drug) through the e-referral system, as usual.

  For the inpatient admission, follow the steps in the "Submit an inpatient authorization" section of the e-referral User Guide (PDF).

If you've been submitting the prior authorization request for CAR-T cell therapy drugs through the e-referral system, this is a change. This change is effective immediately.

If you have questions, email us at MASRX@bcbsm.com.

As a reminder:

• CAR-T cell therapy drugs are covered under the medical benefit. Examples of CAR-T cell therapy drugs are Yescarta^®, Kymriah^®, Tecartus^™, Breyanzi^® and Abecma^®.
• Submit requests for outpatient administration of CAR-T cell drugs through NovoLogix. There is no change to how outpatient requests are submitted.
• Prior authorization for CAR-T drugs is NOT managed by AIM Specialty Health^®.

NovoLogix

NovoLogix offers real-time status checks and immediate approvals for certain medications. If you have access to Provider Secured Services, you already have access to enter authorization requests through NovoLogix.

If you need to request access to Provider Secured Services, complete the Provider Secured Access Application (PDF) form and fax it to the number on the form.

List of requirements

For a list of requirements related to drugs covered under the medical benefit, please see the Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue PPO and BCN Advantage members. (PDF)

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