Abecma^™ to require prior authorization for Medicare Advantage members starting April 5

For dates of service on or after April 5, 2021, the following CAR-T medication will require prior authorization through the NovoLogix^® online tool:

• Abecma (idecabtagene vicleucel), HCPCS code J9999

This applies to Medicare Plus Blue^SM and BCN Advantage^SM members.

Places of service that require authorization

For Medicare Advantage members, we require authorization for all outpatient places of service when you bill these medications as either a professional or a facility service:

• Electronically through an 837P transaction or on a professional CMS-1500 claim form
• Electronically through an 837I transaction or by using the UB04 claim form for a hospital outpatient type of bill 013x

Important reminder

For this drug, submit authorization requests through NovoLogix. It offers real-time status checks and immediate approvals for certain medications. 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 Access Application (PDF) form and fax it to the number on the form.

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 for Medicare Plus Blue PPO and BCN Advantage members.

Posted: April 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network