Announcing changes to management of oncology medical benefit drugs

We’re adding more oncology medical benefit drugs to our Oncology Value Management program administered by OncoHealth. Starting June 1, health care providers should submit prior authorization requests to OncoHealth for the drugs mentioned below.

Notes:

• Some of these changes affect both commercial and Medicare Advantage members; other changes affect only commercial members.
• These updates apply only to members who have requirements under the Oncology Value Management program.

Requirements for new drugs — for commercial and Medicare Advantage members

For dates of service on or after June 1, the drugs listed below will have requirements for Blue Cross Blue Shield of Michigan commercial, Medicare Plus Blue℠, Blue Care Network commercial and BCN Advantage℠ members.

Note: Site-of-care requirements apply only to commercial members.

Changes to requirements

For dates of service on or after June 1, providers will need to submit prior authorization requests through OncoHealth for the drugs listed below. The drugs will be managed under the Oncology Value Management program.

Currently, providers submit prior authorization requests for these drugs through the NovoLogix^® online tool, unless otherwise noted.

For commercial and Medicare Advantage members

Starting June 1, prior authorization requests for the following drugs will be managed by OncoHealth for both commercial and Medicare Advantage members.

For commercial members only

Starting June 1, prior authorizations for the following drugs will be managed by OncoHealth for commercial members. (Currently, providers submit prior authorization requests for these drugs through the NovoLogix online tool.)

Note: For Medicare Advantage members, these drugs are already managed by OncoHealth.

Courses of treatment that start before June 1 and continue beyond June 1

Commercial members who have authorizations that were approved before June 1 for the drugs discussed above can continue to receive therapy until their authorizations expire.

Prior authorization is required through OncoHealth only if there’s a change to the treatment plan on or after June 1, or if treatment with the drug extends beyond the authorization end date.

Removal of prior authorization requirement — for commercial members only

For dates of service on or after June 1, Avzivi^® (bevacizumab-tnjn) won’t require prior authorization for Blue Cross commercial or BCN commercial members.

Note: To determine the requirement for Avzivi for Medicare Advantage members, see the Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue and BCN Advantage members.

Additional information

For more information about the Oncology Value Management program, including information about the members who have requirements under the program and how to submit requests to OncoHealth, see the Oncology Value Management program through OncoHealth: FAQs for providers document and the following pages on ereferrals.bcbsm.com:

• Blue Cross Medical Benefit Drugs
• BCN Medical Benefit Drugs

**For commercial members, drugs may be covered only when administered at the following sites of care: doctor’s or other health care provider’s office; the member's home, administered by a home infusion therapy provider; or an ambulatory infusion center. Site-of-care requirements don’t apply to Medicare Advantage members.

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.

OncoHealth is an independent company supporting Blue Cross Blue Shield of Michigan and Blue Care Network by providing cancer support services.