Lumoxiti no longer requires prior authorization

Lumoxiti™ (moxetumomab pasudotox-tdfk), HCPCS code J9313, no longer requires prior authorization through Carelon Medical Benefits Management (formerly known as AIM Specialty Health^®). This change applies to the following members for dates of service on or after Sept. 30, 2023:

• Blue Cross Blue Shield of Michigan commercial
• All fully insured members (group and individual)
• Members who have coverage through self-funded groups that have opted in to the Carelon medical oncology program. This includes members who have UAW Retiree Medical Benefits Trust non-Medicare plans.
  Note: This change doesn’t apply to members who have coverage through the Blue Cross and Blue Shield Federal Employee Program^®.

• Medicare Plus Blue℠ members
• Blue Care Network commercial members
• BCN Advantage℠ members

This drug is covered under members’ medical benefits, not their pharmacy benefits.

More about prior authorization requirements

For 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 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 Benefits 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

Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.