Avsola to require prior authorization for Blue Cross and Blue Shield Federal Employee Program non-Medicare members starting Jan. 1

For dates of service on or after Jan. 1, 2023, we're adding a prior authorization requirement for Blue Cross and Blue Shield FEP^® non-Medicare members for the following drug covered under the medical benefit:

• Avsola^® (infliximab-axxq), HCPCS code Q5121

For members who begin therapies prior to Dec. 31, 2022

Providers won’t need to submit prior authorization requests. Blue Cross will automatically issue authorizations for the drugs; these authorizations will be valid for six months.

For members who begin therapies on or after Jan. 1

Submit prior authorization requests through the NovoLogix^® online tool. It offers real-time status checks and immediate approvals for  certain medications.

If you have access to our provider portal (availity.com**), you already have access to NovoLogix. If you need access to Availity^®, follow the instructions on the Register for webtools webpage on bcbsm.com/providers.

After you’ve logged in to Availity, click on Payer Spaces and then on the BCBSM and BCN logo. Then you’ll see  links to the NovoLogix tools on the Applications tab.

List of requirements

For a full list of requirements related to drugs covered under the medical benefit, see the Utilization management medical drug list for Blue Cross and Blue Shield Federal Employee Program^® non-Medicare members. We’ll update this list prior to the effective date of the change.

You can access this list and other information about requesting prior authorization at ereferrals.bcbsm.com, at these locations:

• Blue Cross Medical Benefit Drugs page
• BCN Medical Benefit Drugs page

Authorization isn't a guarantee of payment. Health care practitioners need to verify  eligibility and benefits for members.

Availity is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal services.

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