Empaveli^™ to require prior authorization for commercial members starting June and August

Empaveli (pegcetacoplan), HCPCS code J3590, will require prior authorization through the NovoLogix^® online tool for the following members:

• Blue Care Network commercial members, for courses of therapy starting on or after June 28, 2021
• Blue Cross Blue Shield of Michigan commercial members, for courses of therapy starting on or after Aug. 2, 2021

Some Blue Cross commercial 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) members don't participate in the standard prior authorization program.

How to submit prior authorization requests

Submit prior authorization requests through NovoLogix. 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:

• For BCN commercial members: Click BCN and then click Medical Benefit Drugs. In the BCN commercial column, see the "How to submit requests electronically using NovoLogix" section.
• For Blue Cross commercial members: Click Blue Cross and then click Medical Benefit Drugs. In the Blue Cross commercial column, see the "How to submit requests electronically using NovoLogix" section.

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 on 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: June 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network