Additional medical benefit drugs will require prior authorization for URMBT members with Blue Cross non-Medicare plans starting Jan. 1

For dates of service on or after Jan. 1, 2023, Blue Cross Blue Shield of Michigan will manage prior authorizations for additional medical benefit drugs for UAW Retiree Medical Benefits Trust members with Blue Cross non‑Medicare plans.

You’ll find a list of these drugs later in this article. You’ll need to submit prior authorization requests either to AIM Specialty Health^® or through the NovoLogix^® online tool.

These drugs are part of members’ medical benefits, not their pharmacy benefits.

The following requirements don’t apply:

• When these drugs are administered in an inpatient setting
• To the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714)

How to submit prior authorization requests

Note: If you need access to Availity^®, follow the instructions on the Register for web tools webpage at bcbsm.com/providers.

Which drugs will be affected by this change?

The drugs in the following table will be affected by this change.

For information about additional requirements, such as site of care and quantity limits, see the appropriate drug lists. Access the drug list using the links in the "More about the authorization requirements" section later in this article.

⁽¹⁾Prior to Jan. 1, 2023, this drug is a covered benefit but doesn’t require prior authorization.
⁽²⁾Prior to Jan. 1, 2023, this drug isn’t a covered benefit.

More about prior authorization requirements

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 URMBT members with Blue Cross non-Medicare plans, see:

• Medical oncology prior authorization list for UAW Retiree Medical Benefits Trust PPO non‑Medicare members
• Medical Drug Management with Blue Cross for UAW Retiree Medical Benefit 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.

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.