Additional drugs to have requirements for URMBT members with Blue Cross non-Medicare plans

For dates of service on or after March 7, 2024, additional drugs will have a prior authorization requirement, site of care requirement or both for UAW Retiree Medical Benefits Trust members with Blue Cross Blue Shield of Michigan non-Medicare plans.

See the table below for:

• Drug names and procedure codes
• The new requirements
• Where to submit prior authorization requests

These drugs are part of members’ medical benefits, not their pharmacy benefits.

The prior authorization requirement is applied only when the drugs are administered in an outpatient setting.

For the drugs that have a site-of-care requirement, the NovoLogix online tool will prompt you to select a site of care when you submit prior authorization requests. If the request meets clinical criteria for the drug and is for one of the following sites of care, it will be approved automatically:

• Doctor’s or other health care provider’s office
• Ambulatory infusion center
• The member’s home, from a home infusion therapy provider

Prior authorization and site-of-care requirements don’t apply to the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714).

How to submit prior authorization requests

To access the Carelon provider portal or the NovoLogix online tool:

• Log in to our provider portal at availity.com.**
• Click on Payer Spaces in the menu bar and then click on the BCBSM and BCN logo.
• On the Applications tab, click the tile for the Carelon provider portal or the appropriate NovoLogix tool.

If you need to request access to our provider portal, see the Register for web tools page on bcbsm.com.
You can also log in directly to the Carelon provider portal at providerportal.com.**

More about the requirements

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 medical benefits for URMBT members with Blue Cross non-Medicare plans, see:

• Medical Drug Management with Blue Cross for UAW Retiree Medical Benefit Trust PPO non-Medicare Members
• Medical oncology prior authorization list for UAW Retiree Medical Benefits Trust PPO non-Medicare members

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.

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.

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

NovoLogix is an independent company that provides an online prescription drug prior authorization tool for Blue Cross Blue Shield of Michigan and Blue Care Network.