We’re designating preferred and nonpreferred IV iron therapy replacement drugs for Medicare Advantage members

Starting Aug. 8, 2022, we’re designating certain intravenous iron replacement therapy drugs as preferred or nonpreferred for our Medicare Plus Blue℠ and BCN Advantage℠ members. These drugs are covered under members’ medical benefits.

If you are currently treating one of our Medicare Advantage members with a drug that will be designated as nonpreferred, we encourage you to transition to them to a preferred drug as soon as possible.

Preferred medications won’t require prior authorization
The preferred IV iron therapy replacement medications are:

• Ferrlecit^® (sodium ferric gluconate), HCPCS code J2916        
• Feraheme^® (ferumoxytol), HCPCS code Q0138
• Venofer^® (iron sucrose), HCPCS code J1756
• INFeD^® (iron dextran), HCPCS code J1750

Nonpreferred medications will require prior authorization
The nonpreferred IV iron therapy replacement medications are:

• Injectafer^® (ferric carboxymaltose), HCPCS code J1439
• Monoferric^® (ferric derisomaltose), HCPCS code J1437

For dates of service on or after Aug. 8, 2022, we’ll require prior authorization for these nonpreferred IV iron therapy medications.

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

Exception: In line with Original Medicare guidelines, Injectafer and Monoferric won’t require prior authorization when members receive them through a dialysis facility. Refer to the ESRD PPS Drug Designation Process** guidelines published by the Centers for Medicare & Medicaid Services.

When prior authorization is required
We require prior authorization for the nonpreferred drugs when they are administered in any site of care other than inpatient hospital (place of service code 21) and are billed as follows:

• Electronically through an 837P transaction or on a professional CMS-1500 claim form
• Electronically through an 837I transaction or by using the UB04 claim form for a hospital outpatient type of bill 013x

Submitting prior authorization requests
Submit requests for the nonpreferred drugs using the NovoLogix online tool. It offers real-time status checks and immediate approvals for certain medications.

If you have access to the Availity^® Essentials provider portal, you already have access to NovoLogix. If you need to request access to Availity, follow the instructions on the Register for web tools webpage at bcbsm.com/providers.

After you’ve logged in to Availity, click on Payer Spaces and then click on the BCBSM and BCN logo. This will take you to the Blue Cross and BCN payer space, where you’ll find links to the NovoLogix tools on the Applications tab.

List of requirements
For a list of requirements related to drugs covered under the medical benefit, see this list: Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue PPO and BCN Advantage members.

We’ll update the list to reflect these changes prior to the effective date.

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