Aduhelm™ to require prior authorization for commercial members starting July and August
Aduhelm (aducanumab-avwa), HCPCS code J3590, will require prior authorization through the NovoLogix® online tool as follows:
Some Blue Cross commercial groups not subject to these requirements
For Blue Cross commercial members, this authorization requirement applies 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:
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: July 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network