Prior authorization will be required for Opdualag, starting Dec. 1

Most Blue Cross Blue Shield of Michigan and Blue Care Network members will need prior authorization for Opdualag™ for dates of service on or after Dec. 1, 2022. Prior authorization requests must be submitted to AIM Specialty Health^®.

Opdualag (nivolumab and relatlimab-rmbw), HCPCS code J9298, is part of members’ medical benefits, not their pharmacy benefits.

Prior authorization requirements apply when this drug is administered in outpatient settings for:

• Blue Cross commercial:
• Members who have coverage through fully insured groups
• Members with individual coverage
• UAW Retiree Medical Benefits Trust members with Blue Cross commercial, non-Medicare plans
• Medicare Plus Blue℠ members
• BCN commercial members
• BCN Advantage℠ members

More about the authorization requirements

Authorization isn’t a guarantee of payment. As always, health care providers need to verify eligibility and benefits for members.

For additional information on requirements related to drugs covered under the medical benefit, refer to the following drug lists:

• Blue Cross and BCN commercial:
• Medical oncology prior authorization list for Blue Cross commercial fully insured and BCN commercial members
• Blue Cross and BCN utilization management medical drug list
• URMBT members with Blue Cross commercial, non-Medicare plans:
• 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
• Medicare Plus Blue and BCN Advantage members:
• Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue and BCN Advantage members

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

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

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 and Blue Care Network don’t own or control this website.