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January 2015

Prior authorization required for specialty drug Lemtrada™

The following medical specialty drug will require prior authorization starting Jan. 1, 2015:

Lemtrada™ — HCPCS code J3490/J3590

Blue Cross Blue Shield of Michigan reserves the right to add a medical specialty drug to the medical prior authorization program as a product becomes approved by the Food and Drug Administration. Blue Cross will continue to provide an update notification of any drug that will be added to the medical drug PA program.

Certain specialty drugs administered by health care practitioners require prior authorization before they can be covered under our members’ medical benefits. The prior authorization is only a clinical review approval; it is not a guarantee of payment. Health care practitioners will need to verify the member’s coverage for medical benefits.

This helps ensure proper use and addresses potential safety issues for specialty drugs.

You can find medication request forms within the 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).

You must send the authorization request to us in one of the following ways:

  • Fax or mail a physician-signed medical medication request form
  • Upload your request using the online-based tool, NovoLogix.

Standard processing time for review of a request is 15 days. An urgent request is reviewed within 72 hours.

Note: The prior authorization requirement does not apply to Medicare, Medicare Advantage or Federal Employee Program members.

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 2014 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.