Onpattro, Poteligeo, Signifor LAR added to medical benefit specialty drug prior authorization program for commercial members

The prior authorization program for specialty drugs covered under the medical benefit is expanding for BCN HMOSM and Blue Cross PPO commercial members as follows:

Brand name / HCPCS code Prior authorization requirements for all dates of service on or after:
OnpattroTM / J3490 HMO – Nov. 1, 2018
PPO – Dec. 1, 2018
Poteligeo® / J9999 HMO – Nov. 1, 2018 (only for members starting treatment on or after that date)
PPO – None required
Signifor LAR® / J2502 HMO – Feb. 1, 2019
PPO – Already required

These changes don't apply to BCN AdvantageSM, Blue Cross Medicare Plus BlueSM PPO or Federal Employee Program® members.

How to submit authorization requests

Submit authorization requests prior to the start of services for medical benefit drugs that require authorization using the NovoLogix® web tool within Provider Secured Services.

Always verify benefits

Approval of a prior authorization request isn't a guarantee of payment. You need to verify each member's eligibility and benefits. Members are responsible for the full cost of medications not covered under their medical benefit coverage.

Posted: October 2018
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network