Preferred immune globulin products for Medicare Advantage members to change, starting Nov. 1

For dates of service on or after Nov. 1, 2024, preferred and nonpreferred immune globulin products are changing for Medicare Plus Blue℠ and BCN Advantage℠ members.

Health care providers will have to show that Medicare Advantage members have tried the preferred immune globulin products before requesting prior authorization for the nonpreferred products. See the following table:

Note: Use of Gammagard or Octagam is required before starting Hizentra but won’t be required for the diagnosis of chronic inflammatory demyelinating polyneuritis, or CIPD.

Submit prior authorization requests through the NovoLogix^® online tool when these drugs are billed as a medical benefit.

When prior authorization is required

These medications require prior authorization when 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 form
• Electronically through an 837I transaction or using the UB04 claim form for a hospital outpatient type of bill 013X

How to access NovoLogix

To access NovoLogix, log in to our provider portal (availity.com),** click on Payer Spaces in the menu bar and then click on 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 electronic data interchange services.