Vyvgart^™ will have prior authorization and site-of-care requirements for commercial members, starting Jan. 13

Vyvgart (efgartigimod alfa-fcab), HCPCS code J3590, will have prior authorization and site-of-care requirements for Blue Cross Blue Shield of Michigan and Blue Care Network group and individual commercial members starting Jan. 13, 2022.

Some Blue Cross commercial groups not subject to these requirements

For Blue Cross commercial groups, 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.

When submitting requests on or after Jan. 13

To learn how to submit requests through NovoLogix, visit ereferrals.bcbsm.com and do the following:

• 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.
• 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.

When submitting requests before Jan. 13

Prior to Jan. 13, 2022, fax your request for preservice review as follows:

• For Blue Cross commercial members: Fax to Provider Inquiry at 1-866-311-9603.
• For BCN commercial members: Fax to the Medical Drug Help Desk at 1 877 325 5979.

List of requirements

For a full list of requirements related to drugs covered under the medical benefit, see the Blue Cross and BCN utilization management medical drug list for Blue Cross commercial and BCN commercial members (PDF).

We'll update this list with the new Vyvgart requirements prior to the effective date.

Authorization isn't a guarantee of payment. Health care practitioners need to verify eligibility and benefits for members.

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