Enjaymo™ will have prior authorization and site-of-care requirements for commercial members, starting March 17
Enjaymo (sutimlimab-jome), 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 March 17, 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 March 17, 2022
Starting March 17, submit prior authorization requests using the NovoLogix® online tool.
To learn how to submit requests using NovoLogix, do the following on this website:
- 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 March 17, 2022
Prior to March 17, 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 Enjaymo 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: March 2022
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network