Effective Oct. 1, Nivestym and Zarxio are preferred filgrastim products

For dates of service on or after Oct. 1, 2020, the preferred filgrastim products for all Blue Cross Blue Shield of Michigan commercial, Blue Care Network commercial, Medicare Plus Blue^SM and BCN Advantage^SM members will be Nivestym^® (filgrastim-aafi; HCPCS code Q5110) and Zarxio^® (filgrastim-sndz; HCPCS code Q5101).

For commercial members, these requirements apply only to groups currently participating in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. They don’t apply to:

• Non-Medicare members covered through the UAW Retiree Medical Benefits Trust
• Members covered by the Federal Employee Program^® Service Benefit Plan

Patients should take the preferred drugs when possible
Keep this in mind about members prescribed these drugs:

• Members starting treatment on or after Oct. 1 should use a preferred filgrastim product.
• Members currently receiving one of the filgrastim products listed below should transition to Nivestym or Zarxio:
  • Neupogen^® (filgrastim; HCPCS code J1442)
  • Granix^® (tbo-filgrastim; HCPCS code J1447)

We’ll notify commercial members currently taking the nonpreferred drugs and encourage them to discuss treatment options with you.

Here are the authorization requirements for members starting or transitioning to the preferred drugs:

• For Blue Cross commercial members, the preferred drugs don’t require authorization.
• For BCN commercial, Medicare Plus Blue and BCN Advantage members, the preferred drugs require authorization through AIM Specialty Health^®.

Request authorization for patients who must take the nonpreferred drugs
Here are the requirements for members you feel need to take Neupogen or Granix:

• For Blue Cross’ PPO members, authorization is required. Submit request through the NovoLogix^® online tool.
• For BCN commercial, Medicare Plus Blue and BCN Advantage members, both step therapy and authorization are required. Submit the request through AIM Specialty Health.

More about the authorization requirements
Authorization isn’t a guarantee of payment. Health care practitioners need to verify eligibility and benefits for members.

For additional information on requirements related to drugs covered under the medical benefit, see:

• Blue Cross and BCN commercial: Blue Cross and BCN utilization management medical drug list
• Medicare Advantage: Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue PPO and BCN Advantage members

We’ll update the requirements lists with the new information before Oct. 1, 2020.