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July 2021

Additional drugs to require prior authorization for Blue Cross’ URMBT non‑Medicare members

For dates of service on or after Sept. 7, 2021, four more drugs will require prior authorization when administered in an outpatient setting for Blue Cross Blue Shield of Michigan’s UAW Retiree Medical Benefits Trust non‑Medicare members.

Two of these drugs will also be subject to site‑of‑care requirements and waste avoidance quantity limits. All drugs listed in this article are covered under the medical benefit. Refer to the table below for more details.

Drug Site of care Waste avoidance How to submit prior authorization requests
Crysvita® (burosumab)
HCPCS code J0584		 Yes No

Submit prior‑authorization requests through the NovoLogix® online tool. It offers real‑time status checks and immediate approvals for certain medications.
To learn how to submit requests through NovoLogix, follow these steps:

  1. Go to ereferrals.bcbsm.com.
  2. Click on Blue Cross.
  3. Click on Medical Benefit Drugs.
  4. Scroll to the Blue Cross commercial column.
  5. Review How to submit requests electronically using NovoLogix
Luxturna®
(voretigene neparvovec)
HCPCS code J3398		 No No

Submit prior‑authorization requests through the NovoLogix® online tool. It offers real‑time status checks and immediate approvals for certain medications.
To learn how to submit requests through NovoLogix, follow these steps:

  1. Go to ereferrals.bcbsm.com.
  2. Click on Blue Cross.
  3. Click on Medical Benefit Drugs.
  4. Scroll to the Blue Cross commercial column.
  5. Review How to submit requests electronically using NovoLogix
Ultomiris® (ravulizumab)
HCPCS code J1303		 Yes Yes

Submit prior‑authorization requests through the NovoLogix® online tool. It offers real‑time status checks and immediate approvals for certain medications.
To learn how to submit requests through NovoLogix, follow these steps:

  1. Go to ereferrals.bcbsm.com.
  2. Click on Blue Cross.
  3. Click on Medical Benefit Drugs.
  4. Scroll to the Blue Cross commercial column.
  5. Review How to submit requests electronically using NovoLogix
Poteligeo® (mogamulizumab)
HCPCS code J9204		 No No

Submit prior‑authorization requests to AIM Specialty Health® using one of the following methods:

  • Through the AIM ProviderPortal**
  • By calling the AIM Contact Center at 1‑844‑377‑1278

Explanation of other requirements

Through site‑of‑care requirements, members receiving select injectable or infusible drugs in the outpatient hospital setting are redirected to a lower cost, alternate site of care, such as the physician’s office or member’s home.

Through the waste avoidance program, dosing limits for these drugs will be based on weight and will be specific to:

  • The dosing guidelines of the U.S. Food and Drug Administration and the manufacturer
  • Current medical best practices

More about authorization requirements

Authorization isn’t a guarantee of payment. As always, 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:

Note: Accredo manages prior authorization requests for additional medical benefit drugs.

We’ll update our drug lists to reflect the information in this article prior to the effective date.

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2020 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.