Medical specialty drug prior authorization lists changing for Medicare Plus Blue, BCN commercial and BCN Advantage

We’re adding authorization requirements for three specialty drugs covered under the medical benefit for Medicare Plus Blue^SM PPO, BCN commercial and BCN Advantage^SM members.

For dates of service on or after Sept. 25, 2020, the following drugs will require authorization through AIM Specialty Health^®:

• Zepzelca™ (lurbinectedin) — HCPCS codes J3490, J3590, J9999
• Phesgo™ (pertuzumab/trastuzumab/hyaluronidase-zzxf) — HCPCS codes J3490, J3590, J9999
• Nyvepria™ (pegfilgrastim-apgf) — HCPCS codes J3490, J3590, J9999

How to submit authorization requests
Submit authorization requests to AIM using one of the following methods:

• Through the AIM provider portal**
• By calling the AIM Contact Center at 1-844-377-1278

For information about registering for and accessing the AIM ProviderPortal, see the Frequently Asked Questions page** on the AIM website.

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

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

• BCN commercial: 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 PPO and BCN Advantage members

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

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