Rybrevant™ requires prior authorization for dates of service on or after Sept. 27 for most members
For dates of service on or after Sept. 27, 2021, Rybrevant (amivantamab-vmjw), HCPCS codes J9999, J3490, J3590 and C9399, will require prior authorization through AIM Specialty Health®. This drug is covered under the medical benefit.
Prior authorization requirements apply when this drug is administered in outpatient settings for:
- Blue Cross and Blue Shield of Michigan commercial members who have coverage through fully insured groups and who have individual coverage
Exceptions: This requirement doesn't apply to Michigan Education Special Services Association members or members who have coverage through the Michigan Blue Cross and Blue Shield Federal Employee Program®. This requirement also doesn't apply to UAW Retiree Medical Benefits Trust PPO non-Medicare members and other members with coverage through self-funded groups.
- Medicare Plus BlueSM members
- Blue Care Network commercial members
- BCN AdvantageSM members
How to submit authorization requests
Submit authorization requests to AIM using one of the following methods:
- Through the AIM ProviderPortal*
- By calling the AIM Contact Center at 1-844-377-1278
More about the authorization requirements
Authorization isn't a guarantee of payment. As always, 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:
- Blue Cross commercial and BCN commercial: Medical oncology prior authorization list for Blue Cross commercial fully insured and BCN commercial members (PDF)
- Medicare Advantage: Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue and BCN Advantage members (PDF)
We'll update the appropriate drug lists to reflect the information in this message prior to the effective date.
*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 not responsible for its content.
Posted: July 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network