Danyelza, Margenza and Saphnelo to require prior authorization for URMBT members with Blue Cross non-Medicare plans

For dates of service on or after June 30, 2022, the drugs listed below will require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross Blue Shield of Michigan non-Medicare plans. They may also have site of care requirements, quantity limit requirements or both.

These requirements apply when the drugs are administered in an outpatient setting. Also, they don’t apply to the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714).

The listed drugs are covered under the medical benefit. See the table for more information. (When a cell is blank, the drug doesn’t have that requirement.)

Submitting prior authorization requests

Here’s information on how to submit requests:
To submit requests to AIM, use one of the following methods:

• Submit through the AIM ProviderPortal.**
• Call the AIM Contact Center at 1-844-377-1278.

To learn how to submit requests through NovoLogix:

1. Go to our Blue Cross Medical Benefit Drugs page.
2. Scroll to the Blue Cross commercial column.
3. Review the information in the How to submit authorization requests electronically using NovoLogix section.

NovoLogix offers real-time status checks and immediate approvals for certain medications.

Notes:

• Accredo manages prior authorization requests for additional medical benefit drugs for these members.
• Authorization isn’t a guarantee of payment. As always, health care practitioners need to verify eligibility and benefits for our members.

For more information

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 article prior to the effective date.

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 don’t own or control this website.