Cortrophin and Ryplazim to have requirements for URMBT members with Blue Cross non-Medicare plans

For dates of service on or after Sept. 1, 2022, the following drugs will require prior authorization through the NovoLogix^® online tool and may also have site-of-care requirements, quantity limit requirements or both. These requirements will apply to UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans. These drugs are part of members’ medical benefits, not their pharmacy benefits.

See the table for more information. When a cell is blank, the drug doesn’t have that requirement.

Brand name	Generic name	HCPCS code	Requirements
			Prior authorization	Site of care	Quantity limits
Cortrophin®	corticotropin	J3490/J3590	✓
Ryplazim®	plasminogen, human-tvmh	J3590/C9090	✓		✓

These requirements apply only when these drugs are administered in an outpatient setting.

Note: These requirements don’t apply to the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714).

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, go to our Blue Cross Medical Benefit Drugs page, scroll to the Blue Cross commercial column and review the information in the How to submit authorization requests electronically using NovoLogix section.

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 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 pertinent drug lists to reflect the information in this message prior to the effective date.

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