Medical drug prior authorization program expanding

Starting July 1, 2019, Khapzory^™ and Fusilev^® will be added to the Medical Drug Prior Authorization Program for Blue Cross Blue Shield of Michigan PPO commercial members.

• Khapzory (levoleucovorin sodium, HCPCS code J3490)
• Fusilev (levoleucovorin calcium, HCPCS code J0641)

This change applies to members starting therapy on or after July 1. There is nothing needed for members currently on Fusilev or Khapzory. These drugs are already included in the prior authorization program for Blue Care Network HMO^SM commercial members.

The authorization requirement only applies to groups currently participating in the commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. To find a list of groups that don’t take part in the program, follow these steps:

1. Log in to Provider Secured Services.
2. Click on BCBSM Provider Publications and Resources.
3. Click on Newsletters & Resources.
4. Click on Forms.
5. Click on Physician administered medications.
6. Click on BCBSM Medical Drug Prior Authorization Program list of groups that have opted out.

These changes don’t apply to BCN Advantage^SM, Blue Cross Medicare Plus Blue^SM PPO or Federal Employee Program^® members.

A prior authorization approval isn’t a guarantee of payment. Providers need to verify eligibility and benefits for members. Members are responsible for the full cost of medications not covered under their medical benefit coverage.

For a list of requirements for drugs covered under the medical benefit and for directions on how to submit a prior authorization request, see the following resources:

• The Medical Benefit Drugs ‐ Pharmacy page in the Blue Cross section of ereferrals.bcbsm.com
• Blue Cross and BCN utilization management medical drug list

The new prior authorization requirement for Khapzory and Fusilev will be reflected in the medical drug list before the July 1 effective date.