Fylnetra and Rolvedon to require prior authorization for most commercial members starting March 13

Starting March 13, 2023, we're adding prior authorization requirements for most Blue Cross Blue Shield of Michigan and Blue Care Network group and individual commercial members for the following drugs covered under the medical benefit:

• Fylnetra^® (pegfilgrastim-pbbk), HCPCS codes J3590 and C9399
• Rolvedon™ (eflapegrastim-xnst), HCPCS codes J3590 and C9399

When submitting requests on or after March 13

Starting March 13, 2023, submit prior authorization requests for Fylnetra and Rolvedon through the NovoLogix^® online tool. It offers real-time status checks and immediate approvals for certain medications.

To access NovoLogix, log in to our provider portal at availity.com,** click on Payer Spaces in the menu bar and then click on the BCBSM and BCN logo. You’ll find links to the NovoLogix tools on the Applications tab.

Note: If you need to request access to our provider portal, follow the instructions on the Register for web tools webpage on bcbsm.com/providers.

When submitting requests before March 13

Before March 13, 2023, fax requests for preservice review as follows:

• For Blue Cross commercial members: Fax to Provider Inquiry at 1‑866‑311‑9603.
• For BCN commercial members: Fax to the Medical Drug Help Desk at 1‑877‑325‑5979.

Some Blue Cross commercial groups not subject to these requirements

For Blue Cross commercial groups, this authorization requirement applies only to groups that participate in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. To determine whether a group participates in the prior authorization program, see the Specialty Pharmacy Prior Authorization Master Opt-in/out Group list.

Note: Blue Cross and Blue Shield Federal Employee Program^® members and UAW Retiree Medical Benefits Trust (non-Medicare) members don’t participate in the standard prior authorization program.

List of requirements

For a full list of requirements related to drugs covered under the medical benefit, see the Blue Cross and BCN utilization management medical drug list for Blue Cross commercial and BCN commercial 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 on the following pages of the ereferrals.bcbsm.com website:

• Blue Cross Medical Benefit Drugs
• BCN Medical Benefit Drugs

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.