Review requirements for prior authorization of Omisirge

Omisirge^® is a new-to-market cellular therapy that was recently approved by Blue Cross Blue Shield of Michigan’s and Blue Care Network’s Pharmacy and Therapeutics committee.

On May 23, 2023, we published a provider alert stating that Omisirge will require prior authorization for most commercial members for dates of service on or after June 8, 2023. The member must have an approval for a stem cell transplant on file through Blue Cross’ and BCN’s Human Organ Transplant Program before a prior authorization request for Omisirge can be approved.

You can view the complete requirements in our Omisirge medical policy. To access the medical policy:

1. Go to bcbsm.com/providers.
2. Click on Resources.
3. Click on Search Medical Policies.
4. In the Medical Policy Router Search page, type “Omisirge” in the Policy/Topic Keyword field and press Enter.
5. Click on the link to open the Omisirge medical policy.