Nulibry^™ to require authorization for commercial members

Blue Cross Blue Shield of Michigan and Blue Care Network are adding a prior authorization requirement for Nulibry (fosdenopterin), HCPCS codes J3490 and J3590, as follows:

• For BCN commercial members: Prior authorization is required for courses of treatment starting on or after April 5, 2021.
• For Blue Cross commercial members: Prior authorization is required for courses of therapy starting on or after May 3, 2021.

How to submit authorization requests

Submit authorization requests through the NovoLogix^® online tool. It offers real-time status checks and immediate approvals for certain medications.

To learn how to submit requests through NovoLogix, do the following on this website:

• For BCN commercial members: Click BCN and then click Medical Benefit Drugs. In the BCN HMO (commercial) column, see the "How to submit authorization requests electronically using NovoLogix" section.
• For Blue Cross commercial members: Click Blue Cross and then click Medical Benefit Drugs. In the Blue Cross PPO (commercial) column, see the "How to submit authorization requests electronically using NovoLogix" section.

More about the authorization requirements

These authorization requirements apply only to groups that currently participate in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit.

To determine whether a group participates in the prior authorization program, see the Specialty Pharmacy Prior Authorization Master Opt-in/out Group list.

Note: The Blue Cross and Blue Shield Federal Employee Program^® and the UAW Retiree Medical Benefits Trust (non-Medicare) don't participate in the standard prior authorization program.

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

List of requirements

For a list of requirements related to drugs covered under the medical benefit, please see the Blue Cross and BCN utilization management medical drug list for Blue Cross PPO (commercial) and BCN HMO (commercial) members document, which is available from these pages of this website:

• BCN Medical Benefit Drugs
• Blue Cross Medical Benefit Drugs

We'll update the requirements list with this information prior to the effective date.

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