Columvi, Daxxify, Qalsody to require prior authorization for URMBT members with Blue Cross non-Medicare plans

For dates of service on or after July 1, 2024, the drugs listed below will require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross Blue Shield of Michigan non‑Medicare plans.

These drugs are part of members’ medical benefits, not their pharmacy benefits.

See the table below for:

• Drug names and HCPCS codes
• Where to submit prior authorization requests

The prior authorization requirement applies apply only when these drugs are administered in an outpatient setting.

Note: The 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 prior authorization requests

To access the Carelon provider portal or the NovoLogix online tool, log in to our provider portal (availity.com),** click Payer Spaces in the menu bar and then click the BCBSM and BCN logo. On the Applications tab, click the tile for the Carelon provider portal or the appropriate NovoLogix tool.

If you need to request access to our provider portal, see the Register for web tools webpage on bcbsm.com.

You can also log in directly to the Carelon provider portal at providerportal.com.**

More about requirements for medical benefit drugs

For additional information on requirements related to drugs covered under the medical benefit for URMBT members with Blue Cross non-Medicare plans, see:

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

We’ll update the 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 doesn’t own or control this website.

Availity^® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services.

Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services.