Nyvepria, Rybrevant to require prior authorization for URMBT members with Blue Cross non-Medicare plans

For dates of service on or after May 16, 2022, we're adding prior authorization requirements for the following drugs covered under the medical benefit for UAW Retiree Medical Benefits Trust members with Blue Cross Blue Shield of Michigan non-Medicare plans:

• Nyvepria™ (pegfilgrastim-apgf), HCPCS code Q5122
• Rybrevant™ (amivantamab-vmjw), HCPCS code J9061

Submit prior authorization requests through AIM Specialty Health^®.

Notes:

• The prior authorization requirement applies when these drugs are administered in an outpatient setting.
• This requirement doesn’t apply to the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714).

How to submit authorization requests

Submit prior 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 for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans, see:

• Medical oncology prior authorization list for UAW Retiree Medical Benefits Trust PPO non-Medicare members (PDF)
• Medical Drug Management with Blue Cross for UAW Retiree Medical Benefit Trust PPO non-Medicare Members (PDF)

We’ll update the pertinent drug lists to reflect the information in this message prior to the effective date.

Accredo manages prior authorization requests for other medical benefit drugs.

AIM is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to provide benefit management services.

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.