Additional medical benefit drugs to require prior authorization for some Blue Cross commercial members

Starting in June 2021, we’re adding prior authorization requirements for additional drugs covered under the medical benefit for UAW Retiree Medical Benefits Trust non‑Medicare members.

For dates of service on or after June 24, 2021, submit prior authorization requests to AIM Specialty Health^® for these drugs:

• Nivestym^® (filgrastim‑aafi), HCPCS code Q5110
• Udenyca^® (pegfilgrastim‑cbqv), HCPCS code Q5111
• Ontruzant^® (trastuzumab‑dttb), HCPCS code Q5112
• Ziextenzo^® (pegfilgrastim‑bmez), HCPCS code Q5120
• Zirabev™ (bevacizumab‑bvzr), HCPCS code Q5118

How to submit requests
You can submit requests through the AIM ProviderPortal** or 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 for these members, refer to the Medical oncology prior authorization list for UAW Retiree Medical Benefits Trust PPO non‑Medicare members. We’ll update this list to reflect these changes prior to the effective date.

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