Medical specialty drug prior authorization lists will change in November for certain members

For dates of service on or after Nov. 20, 2020, we're removing prior authorization requirements for one drug and adding prior authorization requirements for several drugs.

This affects BCN HMO^SM, Medicare Plus Blue^SM PPO, BCN Advantage^SM and UAW Retiree Medical Benefits Trust PPO non-Medicare members.

Drug that will no longer require prior authorization

For dates of service on or after Nov. 20, we'll no longer require prior authorization for the following drug for Medicare Plus Blue, BCN Advantage and UAW Retiree Medical Benefits Trust PPO non-Medicare members:

• Lartruvo^® (olaratumab), HCPCS code J9285

Drugs that will require prior authorization

For dates of service on or after Nov. 20, we're adding prior authorization requirements for specialty drugs covered under the medical benefit as follows.

• For BCN HMO, Medicare Plus Blue and BCN Advantage members: Providers will have to request prior authorization through AIM Specialty Health^® for the following drugs:
  • Blenrep (belantamab mafodotin-blmf), HCPCS codes J3490, J3590, J9999, C9399
  • Monjuvi^™ (tafasitamab-cxix), HCPCS codes J3490, J3590, J9999, C9399
• For UAW Retiree Medical Benefits Trust PPO non-Medicare members: Providers will have to request prior authorization through AIM for the following drugs:
  • Belrapzo^™ (bendamustine hcl), HCPCS code J9036
  • Doxil^® (doxorubicin liposomal), HCPCS code Q2050
  • Lipodox^® (doxorubicin liposomal), HCPCS code Q2049
  • Herceptin^® (trastuzumab), HCPCS code J9355
  • Imfinzi^® (durvalumab), HCPCS code J9173
  • Imlygic^® (talimogene laherparepvec), HCPCS code J9325
  • Mvasi^™ (bevacizumab-awwb), HCPCS code Q5107

How to submit authorization requests

Submit authorization requests to AIM using one of the following methods:

• Through the AIM provider portal*
• By calling the AIM Contact Center at 1-844-377-1278

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

More about the authorization requirements

Authorization isn't a guarantee of payment. Health care practitioners need to verify eligibility and benefits for members.

For additional information on requirements related to drugs covered under the medical benefit, see the following documents:

• For BCN HMO members
  • Blue Cross and BCN utilization management medical drug list (PDF)
  • Medical Oncology Program (PDF) list
• For Medicare Advantage members: Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue PPO and BCN Advantage members (PDF)
• For UAW Retiree Medical Benefits Trust non-Medicare members: Medical Oncology Prior Authorization List for UAW Retiree Medical Benefits Trust non-Medicare members (PDF)

We'll update these lists with the new information about these drugs prior to the effective dates.

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Posted: September 2020
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network