Fyarro and Tivdak will have requirements for URMBT members with Blue Cross non-Medicare plans

For dates of service on or after Aug. 16, 2022, the drugs listed below will require prior authorization through AIM Specialty Health^® 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
Fyarro™	sirolimus protein-bound particles	J9331	✓
Tivdak®	tisotumab vedotin-tftv	J9273	✓

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 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 for URMBT members with Blue Cross non-Medicare plans, 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

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

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

AIM Specialty Health is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services. For more information, go to our ereferrals.bcbsm.com website.

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