Starting June 22, additional medications will require prior authorization for Medicare Advantage members

For dates of service on or after June 22, 2021, the following medications will require prior authorization through the NovoLogix^® online tool:

• Oxlumo™ (lumasiran), HCPCS code C9074
• Evkeeza™ (evinacumab‑dgnb), HCPCS codes C9399, J3490, J3590
• Nulibry™ (fosdenopterin), HCPCS codes C9399, J3490, J3590

This affects Medicare Plus Blue^SM and BCN Advantage^SM members.

Places of service that require authorization

For Medicare Advantage members, we require authorization for these drugs when they’re administered by a health care professional in a provider office, at the member’s home, in an off‑campus or on-campus outpatient hospital or in an ambulatory surgical center (sites of care 11, 12, 19, 22 and 24) and billed as follows:

• Electronically through an 837P transaction 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

Reminder

Submit authorization requests for these drugs through NovoLogix. It offers real‑time status checks and immediate approvals for certain medications. 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 form and fax it to the number on the form.

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 for Medicare Plus Blue PPO and BCN Advantage members.

We’ll update the list to reflect this change prior to June 22.