Empaveli, Actemra to require prior authorization for Blue Cross URMBT non-Medicare members

For dates of service on or after June 1, 2022, we’re adding prior authorization requirements for the following drugs covered under the medical benefit:

• Empaveli^® (pegcetacoplan), HCPCS codes C9399 and J3490
• Actemra^® (tocilizumab), HCPCS codes J3262, C9399 and J3590

Prior authorization requirements apply when these drugs are administered in an outpatient setting for Blue Cross Blue Shield of Michigan UAW Retiree Medical Benefits Trust non-Medicare members. These requirements don’t apply to the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714).

Note: For members with claims showing use of these drugs prior to June 1, we’ll automatically authorize the drugs for dates of service through Nov. 30, 2022, to provide continuity of care. You’ll need to request authorization for dates of service on or after Dec. 1, 2022.

Submit prior authorization requests using the NovoLogix^® tool. It offers real-time status checks and immediate approvals for certain medications. To learn how to submit requests using the NovoLogix tool, follow these steps:

• Go to ereferrals.bcbsm.com.
• Click on Blue Cross.
• Click on Medical Benefit Drugs.
• Scroll to the Blue Cross commercial column.
• Review the information in the How to submit authorization requests electronically using NovoLogix section.

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 Blue Cross URMBT non-Medicare members, 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

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

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