Ahzantive, Enzeevu, Epysqli, Pavblu to require prior authorization for Medicare Advantage members, starting May 1

For dates of service on or after May 1, 2025, the following drugs will require prior authorization for Medicare Plus Blue℠ and BCN Advantage℠ members:

• Ahzantive^® (aflibercept-mrbb), HCPCS code Q5150
• Enzeevu™ (aflibercept-abzv), HCPCS code Q5149
• Epysqli^® (eculizumab-aagh), HCPCS code Q5151   
• Pavblu™ (aflibercept-ayyh), HCPCS code Q5147

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

When prior authorization is required

These drugs will require prior authorization 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 UB04 claim for a hospital outpatient type of bill 013X

How to access NovoLogix

To access NovoLogix, log in to our provider portal at availity.com,** click on Payer Spaces in the menu bar, 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 For Providers: Register for Web Tools page 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.

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.