Commercial PPO members will need authorization for Eylea and Lucentis

Blue Cross Blue Shield of Michigan members who begin receiving the following therapies on or after Jan. 1, 2020, will require prior authorization:

• Eylea (aflibercept, HCPCS code J0178)
• Lucentis (ranibizumab, HCPCS code J2778)

This requirement applies only to groups that currently participate in the commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit.

To help ensure continuity of care, members who start therapy before Jan. 1 won’t need authorization to continue therapy.

Note: Authorization for these drugs is currently required for BCN HMOSM (commercial), BCN Advantage^SM and Medicare Plus Blue^SM PPO members.

This requirement doesn’t apply to Blue Cross’ PPO members covered under the Federal Employee Program^® Service Benefit Plan.

As a reminder, authorization isn’t a guarantee of payment. Health care providers need to verify eligibility and benefits for their patients.

List of requirements
For a list of requirements related to drugs covered under the medical benefit, see the Requirements for drugs covered under the medical benefit – BCN HMO and Blue Cross PPO document located in the Medical Benefit Drugs – Pharmacy section of the ereferrals.bcbsm.com website.

The authorization requirement for Eylea and Lucentis will be reflected in the requirements list on Jan. 1, 2020.