Pemfexy to require prior authorization for most members starting Feb. 9

For dates of service on or after Feb. 9, 2023, we’ll require prior authorization for Pemfexy^® (pemetrexed), HCPCS code J9304, through AIM Specialty Health^®. This drug 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 Blue Shield of Michigan commercial members who have coverage through UAW Retiree Medical Benefits Trust non-Medicare plans or fully insured groups, or who have individual coverage. Note: This requirement doesn’t apply to members who have coverage through other Blue Cross commercial self-funded groups, including the Blue Cross and Blue Shield Federal Employee Program^®.
• Medicare Plus Blue℠ members
• Blue Care Network commercial members
• BCN Advantage℠ members

How to submit authorization requests

Submit authorization requests to AIM using one of the following methods:

• Through the AIM ProviderPortal, which you can access by doing one of the following:
• Logging in to our provider portal (availity.com**), clicking on Payer Spaces and then clicking on the BCBSM and BCN logo. This takes you to the Blue Cross and BCN payer space where you’ll click the AIM Provider Portal tile.
• Logging in directly to the AIM ProviderPortal at providerportal.com.**
• By calling the AIM Contact Center at 1-844-377-1278

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 commercial 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 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.

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