Rolvedon to require prior authorization for URMBT members with Blue Cross non-Medicare plans

For dates of service on or after May 31, 2023, Rolvedon™ (eflapegrastim-xnst), HCPCS code J1449, will require prior authorization through Carelon Medical Benefits Management (formerly known as AIM Specialty Health^®) for UAW Retiree Medical Benefits Trust members with Blue Cross Blue Shield of Michigan non-Medicare plans.

This drug is covered under the medical benefit.

The prior authorization requirement applies only when Rolvedon is administered in an outpatient setting.

Note: The prior authorization requirement doesn’t apply to the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714).

How to submit authorization requests

Submit prior authorization requests to Carelon using one of the following methods:

• Through the Carelon 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 on the Carelon ProviderPortal tile.
• Logging in directly to the Carelon ProviderPortal at providerportal.com,**
• By calling the Carelon Contact Center at 1-844-377-1278

More about authorization requirement

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

For additional information on requirements related to drugs covered under the medical benefit for URMBT members with Blue Cross non-Medicare plans, see:

• 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

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

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

Carelon Medical Benefits Management (formerly known as 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.

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