We’re adding requirements for 4 drugs covered under medical benefit

For dates of service on or after Dec. 27, 2021, we’re adding requirements when the following drugs are administered in an outpatient setting for UAW Retiree Medical Benefits Trust members with Blue Cross Blue Shield of Michigan non-Medicare plans:
 

• Nulibry™ (fosdenopterin), HCPCS code J3590, will have a prior authorization requirement.
• Avsola™ (infliximab-axxq), HCPCS code Q5121, will have both prior authorization and site-of-care requirements.
• Lemtrada^® (alemtuzumab), HCPCS code J0202, already requires prior authorization. We’re adding a site-of-care requirement.
• Tysabri^® (natalizumab), HCPCS code J2323, already requires prior authorization. We’re adding a site-of-care requirement.

How to submit authorization requests

Submit prior authorization requests through NovoLogix for these drugs. It offers real-time status checks and immediate approvals for certain medications.

To learn how to submit requests through NovoLogix, visit the Medical Benefit Drugs page on the ereferrals.bcbsom.com website. Scroll to the Blue Cross commercial column and review the information in the How to submit authorization requests electronically using NovoLogix section.

As a reminder, authorization isn’t a guarantee of payment. Health care practitioners should always verify eligibility and benefits for members.

For additional information on requirements related to drugs covered under the medical benefit for URMBT members with Blue Cross non-Medicare plans, see:

• Medical Drug Management with Blue Cross for UAW Retiree Medical Benefit Trust PPO non-Medicare Members
• Medical oncology prior authorization list for UAW Retiree Medical Benefits Trust PPO non-Medicare members

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

Note: For other medical benefit drugs, Accredo manages prior authorization requests.