Rybrevant requires prior authorization for most members

For dates of service on or after Sept. 27, 2021, Rybrevant™ (amivantamab-vmjw), HCPCS codes J9999, J3490, J3590 and C9399, will require prior authorization through AIM Specialty Health^®. This drug is covered under the medical benefit.

Prior authorization requirements apply when this drug is administered in outpatient settings for:

• Blue Cross Blue Shield of Michigan commercial members who have coverage through fully insured groups and those with individual coverage

Exceptions: This requirement doesn’t apply to Michigan Education Special Services Association members or members who have coverage through the Blue Cross and Blue Shield Federal Employee Program^®.

This requirement also doesn’t apply to UAW Retiree Medical Benefits Trust members with a Blue Cross non-Medicare plan and other members with coverage through self-funded groups.

• Medicare Plus Blue℠ members
• Blue Care Network commercial members
• BCN Advantage℠ members

How to submit authorization requests

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

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

More about the 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:

• Blue Cross commercial and BCN commercial: Medical oncology prior authorization list for Blue Cross commercial fully insured and BCN commercial members
• Medicare Advantage: Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue and BCN Advantage members

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

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