3 additional medications require prior authorization for Medicare Advantage members

For dates of service on or after Aug. 8, 2022, the following drugs require prior authorization for Medicare Plus Blue℠ and BCN Advantage℠ members:

• Alymsys^® (bevacizumab-maly), HCPCS code J9999
• Amvuttra™ (vutrisiran), HCPCS code J3490
• Releuko^® (filgrastim-ayow), HCPCS code J3590

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

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

When prior authorization is required

These medications require prior authorization when they’re administered by a health care provider in sites of care such as outpatient facilities or physicians’ offices and are 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 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.

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