Rybrevant™ requires prior authorization for dates of service on or after Sept. 27 for most members
For dates of service on or after Sept. 27, 2021, Rybrevant (amivantamab-vmjw), HCPCS codes J9999, J3490, J3590 and C9399, will require prior authorization through AIM Specialty Health®. This drug is covered under the medical benefit.
Prior authorization requirements apply when this drug is administered in outpatient settings for:
Exceptions: This requirement doesn't apply to Michigan Education Special Services Association members or members who have coverage through the Michigan Blue Cross and Blue Shield Federal Employee Program®. This requirement also doesn't apply to UAW Retiree Medical Benefits Trust PPO non-Medicare members and other members with coverage through self-funded groups.
How to submit authorization requests
Submit authorization requests to AIM using one of the following methods:
More about the authorization requirements
Authorization isn't a guarantee of payment. As always, health care practitioners need to verify eligibility and benefits for members.
For additional information on requirements related to drugs covered under the medical benefit, see:
We'll update the appropriate drug lists to reflect the information in this message prior to the effective date.
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Posted: July 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network