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June 2018

Laborers’ Metropolitan Detroit Health Care Fund group will participate in medical drug prior authorization program

Beginning Aug. 1, 2018, Laborers’ Metropolitan Detroit Health Care Fund will participate in the medical drug prior authorization program.

You can find information about the medical drug prior authorization program by logging into web-DENIS, clicking on BCBSM Provider Publications and Resources, and selecting Newsletters and Resources. The information is located under Forms in a section titled Physician administered medications.

Keep in mind that the prior authorization requirement doesn’t apply to Federal Employee Program® members.

The list below reflects all the medications that are part of the medical drug prior authorization program.

Drugs in the medical drug prior authorization program

Actemra®

Elaprase®

Kalbitor®

Remicade®

Acthar® gel

Elelyso™

Kanuma™

Ruconest®

Adagen®

Entyvio™

Krystexxa®

Signifor® LAR

Aldurazyme®

Exondys 51™

Lemtrada™

Simponi Aria®

Aralast NP™

Fabrazyme®

Lumizyme®

Soliris®

Aveed®

Fasenra™

Luxturna™

Spinraza™

Benlysta®

Firazyr®

Makena®

Stelara®

Berinert®

Flebogamma® DIF

Mepsevii™

Stelara IV®

Bivigam™

Gammagard Liquid®

Myobloc®

Synagis®

Botox®

Gammagard® S/D

Myozyme®

Testopel®

Brineura™

Gammaked®

Naglazyme®

Tysabri®

Carimune® NF

Gammaplex®

Nplate®

Vimizim™

Cerezyme®

Gamunex®

Nucala®

Vpriv®

Cimzia®

Glassia™

Ocrevus™

Xeomin®

Cinqair®

Hizentra®

Octagam®

Xgeva®

Cinryze®

HyQvia®

Orencia®

Xiaflex®

Cosentyx™

Ilaris®

Privigen®

Xolair®

Crysvita®

Ilumya™

Prolastin®-C

Yescarta®

Cuvitru®

Immune globulin

Prolia®

Zemaira®

Dysport®

Inflectra™

Radicava™

Zinplava™

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.