Step therapy requirements added for Soliris, Ultomiris, Simponi Aria for Medicare Advantage members, starting Feb. 3

For dates of service on or after Feb. 3, 2025, health care providers will have to show that our Medicare Plus Blue℠ and BCN Advantage℠ members have tried and failed certain drugs when requesting prior authorization for the following:

• Soliris^® (eculizumab), HCPCS code J1300
• Ultomiris^® (ravulizumab-cwvz), HCPCS code J1303
• Simponi Aria^® (golimumab), HCPCS code J1602

Refer to the table below for the step therapy requirements.

Submit prior authorization requests through the NovoLogix^® online tool when these drugs will be billed under medical benefits.

When prior authorization is required

These drugs require prior authorization, as applicable, when they are administered by a health care provider in sites of care such as outpatient facilities or physician offices and are billed in one of the following ways:

• Electronically through an 837P transaction or on a professional CMS-1500 claim
• Electronically through an 837I transaction or using the UB-04 claim for hospital outpatient type of bill 013X

How to access NovoLogix

To access NovoLogix, log in to our provider portal (availity.com),** click Payer Spaces in the menu bar, and then click the BCBSM and BCN logo. You’ll find links to the NovoLogix tools on the Applications tab. 

Note: If you need to request access to our provider portal, 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.

We’ll update this list before the effective date.

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

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