Medicare Part B medical specialty drug prior authorization lists changing in 2019

Some updates are coming for the Part B medical specialty medical prior authorization drug list for Blue Cross Medicare Plus Blue^SM PPO and BCN Advantage^SM members. These changes include additions and removals from the prior authorization program as follows.

Medicare Plus Blue PPO

Removals — for dates of service starting Jan. 1, 2019:

• J0202 Lemtrada^®
• J2323 Tysabri^®
• J2350 Ocrevus^®

Additions — for dates of service starting Feb. 1, 2019:

• C9036 Onpattro™
• J2840 Kanuma^®
• J2860 Sylvant^®
• J3357 Stelara^® SQ
• J3358 Stelara^® IV
• J1746 Trogarzo™
• J9022 Tecentriq^®
• J9023 Bavencio^®
• J9042 Adcetris^®
• J9176 Empliciti^®
• J9308 Cyramza^®
• J9352 Yondelis^®

For Medicare Plus Blue, we require prior authorization for these medications when you bill them on a professional CMS-1500 claim form or by electronic submission via an 837P transaction, for the following sites of care:

• Physician office (place of service code 11)
• Outpatient facility (place of service code 19, 22 or 24)

We don’t require authorization for these medications when you bill them on a facility claim form (such as a UB04) or electronically via an 837I transaction.

BCN Advantage

Removals — for dates of service starting Jan. 1, 2019:

• J9032 Beleodaq^®
• J9310 Rituxan^®

Additions — for dates of service starting Feb. 1, 2019:

• J2860 Sylvant^®
• J3357 Stelara^® SQ
• J3358 Stelara^® IV
• J3490/C9399 Onpattro™
• J1746 Trogarzo™
• J9022 Tecentriq^®
• J9023 Bavencio^®
• J9042 Adcetris^®
• J9176 Empliciti^®
• J9352 Yondelis^®

For BCN Advantage, we require prior authorization for these medications when you bill them on a professional CMS-1500 claim form (or submit them electronically via an 837P transaction) or on a facility claim form such as a UB04 (or submit them electronically via an 837I transaction), for the following sites of care: 

• Physician office (place of service code 11)
• Outpatient facility (place of service code 19, 22 or 24)
• Home (place of service code 12)

Reminder: You must get authorization prior to administering these medications. Use the NovoLogix^® online tool to quickly submit your requests.