Changes coming to preferred products for pegfilgrastim (reference product Neulasta^®) for commercial and Medicare Advantage members, starting April 1

For dates of service on or after April 1, 2022, we're making the following changes to the medications designated as preferred and nonpreferred pegfilgrastim products (reference product: Neulasta):

• Preferred products:
  • Neulasta^®/Neulasta^® Onpro^® (pegfilgrastim), HCPCS code J2506
  • Fulphila^® (pegfilgrastim-jmdb), HCPCS code Q5108
  • Ziextenzo^® (pegfilgrastim-bmez), HCPCS code Q5120
• Nonpreferred products:
  • Udenyca^® (pegfilgrastim-cbqv), HCPCS code Q5111
  • Nyvepria^™ (pegfilgrastim-apgf), HCPCS code Q5122

This change affects select Blue Cross Blue Shield of Michigan commercial members, all Blue Care Network commercial members, all Medicare Plus Blue^SM members and all BCN Advantage^SM members. (See the “Additional information for Blue Cross commercial members” section of this message for more information.)

Here's what you need to know when prescribing these products:

• For commercial members: Members must transition to a preferred product by April 1, 2022.
• For Medicare Advantage members (Medicare Plus Blue or BCN Advantage):
  • For members who start courses of treatment on or after April 1: Prescribe preferred products when possible. The “Submitting requests for prior authorization” section of this message describes how to submit requests for preferred products and — for members who can't receive preferred products — how to submit requests for nonpreferred products.
  • For members who receive nonpreferred products for courses of treatment that start before April 1: These members can continue their courses of treatment using the nonpreferred product until their authorizations expire.

Submitting requests for prior authorization

Here's how to submit prior authorization requests for preferred products and for nonpreferred products.

• Preferred products: These products require prior authorization through AIM Specialty Health^®. Submit the request through the AIM provider portal* or by calling the AIM Contact Center at 1-844-377-1278.
• Nonpreferred products — for members who must take nonpreferred products: Submit the prior authorization request through the NovoLogix^® online tool. NovoLogix offers real-time status checks and immediate approvals for certain medications. 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.

Additional information for Blue Cross commercial members

The requirements outlined in this message apply as follows:

• These requirements apply only to Blue Cross commercial groups that participate in the standard commercial Medical Drug Prior Authorization program for drugs covered under the medical benefit.
• These requirements don't apply to UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans.
• For Blue Cross commercial self-funded groups other than UAW Retiree Medical Benefits Trust:
  • For preferred products: These groups don't participate in the AIM oncology management program. Because of this, you don't need to request prior authorization for members who have coverage through these groups.
  • For nonpreferred products: You'll need to request prior authorization through NovoLogix for members who have coverage through these groups.

List of requirements

See the following lists to view requirements for these products.

• For commercial members, see:
  • Standard commercial medical drug program: Blue Cross and BCN utilization management medical drug list for Blue Cross commercial and BCN commercial (PDF)
  • Medical oncology drug program: Medical oncology prior authorization list for Blue Cross and BCN commercial members (PDF)
• For Medicare Advantage members, see the Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue^SM and BCN Advantage^SM members (PDF).

We'll update the lists to reflect these changes prior to the effective date.

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Posted: January 2022
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network