Kimmtrak® and Tivdak® to require prior authorization for most members starting May 23
For dates of service on or after May 23, 2022, we're adding prior authorization requirements for the following drugs covered under the medical benefit:
Prior authorization requirements apply when these drugs are administered in outpatient settings for:
Exceptions: These requirements don't apply to Blue Cross members who have coverage through the Blue Cross and Blue Shield Federal Employee Program®, to UAW Retiree Medical Benefits Trust non-Medicare members or to other Blue Cross commercial members with coverage through self-funded groups.
How to submit authorization requests
Submit authorization requests to AIM Specialty Health® using one of the following methods:
For information about registering for and accessing the AIM ProviderPortal, refer to the Frequently asked questions page* on the AIM website.
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.
*Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're not responsible for its content.
Posted: March 2022
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network