Medicare Part B medical specialty drug prior authorization list changing in October

We’re adding the following medications to the Medicare Plus Blue^SM PPO and BCN Advantage^SM Part B specialty prior authorization drug list.

For dates of service on or after Oct. 1, 2019, the following medications will require prior authorization:

• J1599 Asceniv™
• J1301 Radicava^®
• J0584 Crysvita^®
• J0565 Zinplava™

Medicare Plus Blue PPO

We require prior authorization for these medications when you bill them electronically through an 837P transaction or on a professional CMS-1500 claim form for the following sites of care:

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

BCN Advantage

We require prior authorization for these medications when you bill them as a professional service or as an outpatient facility service and you bill electronically through an 837P transaction or on a professional CMS-1500 claim form for:

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

We also require prior authorization when you bill electronically through an 837I transaction or using a UB04 claim form for a hospital outpatient type of bill 013x.

Reminders

• You must obtain authorization before administering these medications. Use the NovoLogix^® online tool to quickly submit your authorization requests. It offers real-time status checks and immediate approvals for certain medications.
• For Medicare Plus Blue, you can fax an Addendum P form to gain access to the NovoLogix online tool.
• For BCN Advantage, if you have access to Provider Secured Services, you already have access to enter authorization requests through NovoLogix.