May 2024
Elrexfio, Talvey to require prior authorization for most members, starting June 20
For dates of service on or after June 20, 2024, the following drugs will require prior authorization through the Oncology Value Management program:
- Elrexfio™ (elranatamab-bcmm), HCPCS code J1323
- Talvey™ (talquetamab-tgvs), HCPCS code J3055
The Oncology Value Management program is administered by Carelon Medical Benefits Management. These drugs are part of members’ medical benefits, not their pharmacy benefits.
Prior authorization requirements apply when these drugs are administered in outpatient settings for:
- Blue Cross Blue Shield of Michigan commercial:
- All fully insured members (group and individual)
- Members who have coverage through self-funded groups that have opted in to the Oncology Value Management program.
- Although UAW Retiree Medical Benefits Trust non-Medicare plans have opted into this program, these requirements may not apply. Refer to their medical oncology drug list, which is linked below.
- This requirement doesn’t apply to members who have coverage through the Blue Cross and Blue Shield Federal Employee Program®.
- Medicare Plus Blue℠ members
- Blue Care Network commercial members
- BCN Advantage℠ members
How to submit prior authorization requests
Submit prior authorization requests to Carelon using one of the following methods:
Drug lists
For additional information on requirements related to drugs covered under the medical benefit, refer to the following drug lists:
- Blue Cross commercial and BCN commercial:
- URMBT members with Blue Cross non-Medicare plans:
- Medicare Plus Blue and BCN Advantage members:
We’ll update the pertinent drug lists to reflect the information in this message prior to the effective date.
As a reminder, prior authorization isn’t a guarantee of payment. Health care practitioners need to verify eligibility and benefits for members.
**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.
Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services. |