Medicare Part B medical specialty drug prior authorization list is changing in March

We're adding medications to the Medicare Plus BlueSM PPO and BCN AdvantageSM Part B medical specialty prior authorization drug list. These specialty medications are administered in outpatient sites of care, such as a physician's office, an outpatient facility or a member's home.

For dates of service on or after March 16, 2020, you'll need to request authorization for the following medications through the system specified below.

Through the NovoLogix® online tool

  • J3590 Adakveo®
  • J3490 Scenesse®
  • J3490 Reblozyl®

Through the AIM Specialty Health® ProviderPortalSM

  • J9309 Polivy™
  • J9036 Belrapzo™
  • J9118 Asparlas™
  • J9313 Lumoxiti™
  • J9356 Herceptin Hylecta™
  • Q5116 Trazimera™
  • Q5117 Kanjiti™
  • Q5118 Zirabev™

How to bill

For Medicare Plus Blue and BCN Advantage, we require authorization for these medications for all outpatient sites of care when you bill the medications as a professional service or as an outpatient facility service and you bill as follows:

  • Electronically through an 837P transaction or on a professional CMS-1500 claim form

    • or

  • Electronically through an 837I transaction or using a UB04 claim form for a hospital outpatient type of bill 013x

Important reminder

Depending on the medication, you can quickly submit authorization requests through NovoLogix or through AIM.

  • NovoLogix: You can access NovoLogix through Provider Secured Services. It offers real-time status checks and immediate approvals for certain medications. Also note:
    • For Medicare Plus Blue, if you have a Type 1 (individual) NPI and you checked the "Medical Drug PA" box when you completed the Provider Secured Services Application form, you already have access to NovoLogix. If you didn't check that box, you can complete an Addendum P form to request access to NovoLogix and fax it to the number on the form.
    • For BCN Advantage, if you have access to Provider Secured Services, you already have access to enter authorization requests through NovoLogix.

    • If you need to request access to Provider Secured Services, complete the Provider Secured Services Application form and fax it to the number on the form.

  • AIM: You can submit authorizations through the AIM ProviderPortal or by calling AIM at 1-844-377-1278.

For information about registering for and accessing the AIM ProviderPortal, see the Frequently asked questions page on the AIM Specialty Health website*.

List of requirements

For a list of requirements related to drugs covered under the medical benefit, please see the Medical Drug and Step Therapy Prior Authorization List.

*Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're required to let you know we're not responsible for its content.

Posted: December 2019
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network