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May 2014
Additional specialty medical drugs require prior authorization starting July 1
Thirteen additional specialty drugs administered by health care practitioners will require prior authorization by BCBSM in order to be covered under members’ medical benefits, starting July 1, 2014.
Ensuring proper utilization and addressing the potential safety issues of these high-cost medications will address concerns that many of our major group customers have expressed.
The following drugs will require prior authorization starting July 1, 2014:
Drug name |
Procedure code |
Bivigam™ |
J1556 |
Carimune® NF |
J1566 |
Flebogamma® DIF |
J1572 |
Gammagard® Liquid or S/D |
J1569 |
Gammaplex® |
J1557 |
Gamunex® (IV and SubQ) |
J1561 |
Hizentra® (SubQ only) |
J1559 |
Octagam® |
J1568 |
Privigen® |
J1459 |
Ig, IV injection, NOS |
J1599 |
Immune globulin |
*90283 |
Immune globulin |
*90284 |
Immune globulin |
*90399 |
You can find a complete list of medications that require prior authorization on web-DENIS:
- Click on BCBSM Provider Publications and Resources.
- Click on Commercial Pharmacy Prior Authorization and Step Therapy forms.
- Click on Physician administered medications (on the right side under Frequently used forms).
Criteria for authorization of these medications are included on web-DENIS. We will not consider a request for coverage until we receive a physician-signed medication request form for review or the request uploaded onto the online-based tool, Novologix. Requests will follow BCBSM timeframes for coverage determination.
Blue Cross Blue Shield of Michigan reserves the right to change this list at any time.
Obtaining prior authorization
To obtain prior authorization, follow these steps:
- Click on BCBSM Provider Publications and Resources.
- Click on Commercial Pharmacy Prior Authorization and Step Therapy forms.
- Click on Physician administered medications (on the right side under Frequently used forms).
Note: The prior authorization requirement does not apply to Medicare, Medicare Advantage or Federal Employee Program® members. Refer to the opt-out list for groups that currently do not require members to participate in this program.
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