Additional medical benefit specialty drugs require prior authorization for Blue Cross' PPO and BCN HMO^SM members

This message, originally published on May 31, 2019, is republished on June 3, 2019, to include information about Zolgensma^®.

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

• Asceniv^™ (immune globulin, HCPCS code J1599)
• Evenity^™ (rosmosozumab-aqqb, HCPCS code J3590)
• Zolgensma (onasemnogene abeparvovec-xioi, HCPCS codes J3490/J3590)

For BCN HMO members:

• Authorization for Asceniv, Evenity and Zolgensma is required for dates of service on or after June 1, 2019.
• Asceniv and Evenity will be added to the Site of Care Program for BCN HMO members effective June 1, 2019.

For Blue Cross' PPO members:

• Authorization for Asceniv is required for dates of service on or after June 1, 2019. Asceniv will also be added to the Site of Care Program for Blue Cross' PPO members, effective June 1, 2019.
• Authorization for Evenity and Zolgensma is required for dates of service on or after Aug. 1, 2019.

More about the authorization requirements

The authorization requirements apply only to groups that are currently participating in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. These changes don't apply to BCN Advantage^SM, Medicare Plus Blue^SM PPO or Federal Employee Program^® members.

A prior authorization approval isn't a guarantee of payment. Health care practitioners need to verify eligibility and benefits for members.

List of requirements

For a list of requirements related to drugs covered under the medical benefit, please see the Requirements for drugs covered under the medical benefit - BCN HMO and Blue Cross PPO document located on this website:

• The Blue Cross Medical Benefit Drugs - Pharmacy webpage
• The BCN Medical Benefit Drugs - Pharmacy webpage

The new prior authorization requirements that took effect on June 1 are included in the requirements list. The requirements that take effect on Aug. 1 will be reflected in the requirements list before that date. Blue Cross Blue Shield of Michigan and Blue Care Network reserve the right to review for medical necessity prior to the effective dates listed in this message.