Prior authorization required for Spevigo for Medicare Advantage members

A prior authorization requirement has been added for Medicare Plus Blue℠ and BCN Advantage℠ members for dates of service on or after Sept. 26, 2022, for the following medication:

• Spevigo^® (spesolimab-sbzo), HCPCS code J3590

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

This medication is part of members’ medical benefits, not their pharmacy benefits.

When prior authorization is required

This medication requires prior authorization when it’s administered by a health care provider in an outpatient facility or a physician’s office and billed in one of the following ways:

• 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

Submit prior authorization requests through the NovoLogix tool

If you have access to the Availity Essentials provider portal (availity.com**), you already have access to NovoLogix. If you need to request access to Availity^®, follow the instructions on the Register for webtools 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 the Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue PPO and BCN Advantage members.

We updated the list to reflect this change.

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 website don’t own or control this website.