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Author: Admin | 2025-04-28
Assessment form LTACH assessment form You can find these forms and additional resources on the following pages of our ereferrals.bcbsm.com website: Blue Cross Post-Acute Care BCN Post-Acute Care Home & Community Care is an independent company that managed prior authorizations for post-acute care services for Blue Cross Blue Shield of Michigan and Blue Care Network members who have Medicare Advantage plans. Step therapy requirements added for Soliris, Ultomiris, Simponi Aria for Medicare Advantage members, starting Feb. 3 For dates of service on or after Feb. 3, 2025, health care providers will have to show that our Medicare Plus Blue℠ and BCN Advantage℠ members have tried and failed certain drugs when requesting prior authorization for the following: Soliris® (eculizumab), HCPCS code J1300 Ultomiris® (ravulizumab-cwvz), HCPCS code J1303 Simponi Aria® (golimumab), HCPCS code J1602 Refer to the table below for the step therapy requirements. Drugs Diagnosis Step therapy requirements Preferred products that don’t require prior authorization Soliris Ultomiris Myasthenia gravis Trial and failure of rituximab Important: This new requirement is in addition to the requirements announced in the Jan. 10, 2024, provider alert. Ruxience® (rituximab-pvvr), HCPCS code Q5119 Riabni® (rituximab-arrx), HCPCS code Q5123 — for dates of service on or after Jan. 1, 2025 Simponi Aria All Trial and failure of infliximab Renflexis® (infliximab-abda), HCPCS code Q5104 Avsola® (infliximab-axxq), HCPCS code Q5121 Submit prior authorization requests through the NovoLogix® online tool when these drugs will be billed under medical benefits. When prior authorization is required These drugs require prior authorization, as applicable,
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