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

We’re adding medications to the Medicare Plus Blue^SM and BCN Advantage^SM Part B medical specialty prior authorization drug list. These specialty medications are administered in outpatient sites of care, such as a physician’s office, an outpatient facility or a member’s home.

For dates of service on or after March 16, 2020, you’ll need to request authorization for the following medications through the system specified below.

NovoLogix:

• J3590 Adakveo^®
• J3490 Scenesse^®
• J3490 Reblozyl^®

AIM Specialty Health^® ProviderPortal^SM:

• J9309 Polivy^™
• J9036 Belrapzo^™
• J9118 Asparlas^™
• J9313 Lumoxiti^™
• J9356 Herceptin Hylecta^™
• Q5116 Trazimera^™
• Q5117 Kanjiti^™
• Q5118 Zirabev^™

How to bill
For Medicare Plus Blue and BCN Advantage, we require authorization for all outpatient sites of care and when you bill these medications as a professional service or as an outpatient facility service:

• Electronically through 837P or on a professional CMS-1500 claim form
• Electronically through an 837I transaction or by using the UB04 claim form for a hospital outpatient type of bill 013x

NovoLogix authorization requests
You can access NovoLogix through Provider Secured Services. It offers real-time status checks and immediate approvals for certain medications. Also note:

• For Medicare Plus Blue, if you have a Type 1 (individual) NPI and you checked the “Medical Drug PA” box when you completed the Provider Secured Services application form, you already have access to NovoLogix. If you didn’t check that box, you can complete an Addendum “P” to request access to NovoLogix and fax it to the number provided on the form.
• For BCN Advantage, if you have access to Provider Secured Services, you already have access to enter authorization requests through NovoLogix.

If you need to request access to Provider Secured Services, complete the Provider Secured Access Application and fax it to the number provided on the form.

AIM authorization requests
You can submit authorizations through the AIM ProviderPortal or by calling 1-844-377-1278. For information about accessing the AIM ProviderPortal, see the Frequently Asked Questions page on the AIM website.**

List of requirements
For a list of requirements related to drugs covered under the medical benefit, see the Medical Drug and Step Therapy Prior Authorization List.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.