Drugs to require prior authorization for Blue Cross URMBT non‑Medicare members, starting March 10

For dates of service on or after March 10, 2022, certain drugs administered in an outpatient setting will require prior authorization for Blue Cross Blue Shield of Michigan’s UAW Retiree Medical Benefits Trust non-Medicare members. Some of these drugs will also be subject to site-of-care requirements. All these drugs are covered under the medical benefit.

Submit prior authorization requests using the NovoLogix^® online tool.

Refer to the table below for the details. When a cell is blank, the drug doesn’t have site-of-care requirements.

Before the effective date, we’ll update the appropriate drug lists to reflect the information in this message.

Site-of-care requirements explanation

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 a member’s home.

How to submit authorization requests

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

To learn how to submit requests through NovoLogix, do the following:

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 the section, How to submit authorization requests electronically using NovoLogix.

More about the 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 paid under the medical benefit for Blue Cross’ URMBT non-Medicare members, see:

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

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