Prior authorization lists changing for Medicare Plus Blue, BCN and BCN Advantage members

We’re adding authorization requirements for four specialty drugs covered under the medical benefit for Medicare Plus Blue^SM, BCN commercial and BCN Advantage^SM members. The drugs (listed below) will require authorization through AIM Specialty Health^®.

For dates of service on or after July 24, 2020:

• Trodelvy™ (sacituzumab govitecan-hziy; HCPCS codes J3490, J3590, J9999)
• Jelmyto™ (mitomycin; HCPCS codes J3490, J3590, J9999)
• Darzalex Faspro™ (daratumumab and hyaluronidase-fihj; HCPCS codes J3490, J3590, J9999)

For dates of service on or after Aug. 24, 2020:

• Imlygic^® (talimogene laherparepvec; HCPCS code J9325)

How to submit AIM authorization requests

• Call the Contact Center at 1-844-377-1278.
• Use the AIM ProviderPortal**

To learn more about the AIM ProviderPortal, check out their Frequently Asked Questions page** and register for an account.**

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

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

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

We’ll update these lists with the new drug information before the effective dates.

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