Leqembi to require prior authorization for Medicare Advantage members starting Jan. 13

For dates of service on or after Jan. 13, 2023, we’ve added a prior authorization requirement for Medicare Plus Blue℠ and BCN Advantage℠ members for the following drug:

• Leqembi™ (lecanemab-irmb), HCPCS code J3590

This drug is a part of members’ medical benefits, not their pharmacy benefits.

When prior authorization is required

Leqembi requires prior authorization when it’s administered by a health care provider in sites of care such as outpatient facilities or physician offices, and is 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 using the UB04 claim form for a hospital outpatient type of bill 013x

Submit prior authorization requests through the NovoLogix tool

To access NovoLogix, log in to our provider portal (availity.com),** click on Payer Spaces and then click 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. 

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

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 and BCN Advantage 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.