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Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Bluesm and BCN Advantagesm Members Revised September 2021

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Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Bluesm and BCN Advantagesm Members Revised September 2021 Medical Drug and Step Therapy Prior Authorization List for Medicare Plus BlueSM and BCN AdvantageSM members Revised September 2021 This document lists the medical benefit drugs that have authorization or step therapy requirements for Medicare Advantage members. See the revision history at the end of this document for information about changes to this list. Prior authorization Submit authorization requirement effective date request through AIM HCPCS Step therapy Medicare BCN Specialty codes Generic name Trade name requirement Plus Blue Advantage NovoLogix® Health® C9076 Lisocabtagene maraleucel Breyanzi® 2/11/2021 2/11/2021 C9078 Trilaciclib Cosela™ 5/24/2021 5/24/2021 C9079 Evinacumab-dgnb Evkeeza™ 6/22/2021 6/22/2021 C9080 Melphalan flufenamide Pepaxto® 5/24/2021 5/24/2021 G2082 Esketamine Spravato® 2020 2020 (up to 56 mg plus observation) G2083 Esketamine Spravato® 2020 2020 (greater than 56 mg plus observation) 1 Medical Drug and Step Therapy Prior Authorization List for Medicare Plus BlueSM and BCN AdvantageSM members Revised September 2021 Prior authorization Submit authorization requirement effective date request through AIM HCPCS Step therapy Medicare BCN Specialty codes Generic name Trade name requirement Plus Blue Advantage NovoLogix® Health® J0129 Abatacept Orencia® 2017 2018 Try/fail Inflectra® or Renflexis®. These preferred drugs don’t require authorization. J0178 Aflibercept Eylea® 2017 2017 J0179 Brolucizumab-dbll Beovu® 2020 2020 J0180 Agalsidase beta Fabrazyme® 2017 2017 J0221 Alglucosidase alfa, 10mg Lumizyme® 2017 2017 J0222 Patisiran Onpattro® 2019 2019 J0223 Givosiran Givlaari® 2020 2020 J0224 Lumasiran Oxlumo™ 6/22/2021 6/22/2021 J0256 Alpha 1-proteinase inhibitor Aralast NP®, 2017 2017 (human), NOS, 10mg Prolastin C®, Zemaira® J0257 Alpha 1-proteinase inhibitor Glassia® 2017 2017 (human), 10mg J0490 Belimumab Benlysta® 2017 2018 J0517 Benralizumab Fasenra® 2018 2018 J0565 Bezlotoxumab Zinplava™ 2019 2019 2 Medical Drug and Step Therapy Prior Authorization List for Medicare Plus BlueSM and BCN AdvantageSM members Revised September 2021 Prior authorization Submit authorization requirement effective date request through AIM HCPCS Step therapy Medicare BCN Specialty codes Generic name Trade name requirement Plus Blue Advantage NovoLogix® Health® J0584 Burosumab-twza Crysvita® 2019 2019 J0585 Injection,onabotulinumtoxin A Botox® 2017 2017 J0586 Injection,abobotulinumtoxin A Dysport® 2017 2017 J0587 Injection,rimabotulinumtoxin B Myobloc® 2017 2017 J0588 Injection,incobotulinumtoxin A Xeomin® 2017 2017 J0638 Canakinumab Ilaris® 2020 2020 J0641 Levoleucovorin Fusilev® 2020 2020 J0642 Levoleucovorin Khapzory™ 2020 2020 J0717 Certolizumab pegol Cimzia® 2017 2018 J0775 Collagenase clostridium Xiaflex® 2017 2017 histolyticum J0791 Crizanlizumab Adakveo® 2020 2020 J0896 Luspatercept-aamt Reblozyl® 2020 2020 J0897 Denosumab Prolia® 2017 2017 J0897 Denosumab Xgeva® 2020 2017 J1300 Eculizumab Soliris® 2017 2018 J1301 Edaravone Radicava® 2019 2019 J1303 Ravulizumab-cwvz Ultomiris® 2019 2019 3 Medical Drug and Step Therapy Prior Authorization List for Medicare Plus BlueSM and BCN AdvantageSM members Revised September 2021 Prior authorization Submit authorization requirement effective date request through AIM HCPCS Step therapy Medicare BCN Specialty codes Generic name Trade name requirement Plus Blue Advantage NovoLogix® Health® J1322 Elosulfase alfa Vimizim® 2017 2017 J1325 Epoprostenol Flolan®, 2017 2017 Veletri® J1427 Viltolarsen Viltepso® 1/1/2021 1/1/2021 J1428 Eteplirsen Exondys 51® 2020 2020 J1429 Golodirsen Vyondys 53® 2020 2020 J1442 Filgrastim Neupogen® 2020 2020 Use the following preferred filgrastim biosimilar drugs first: Nivestym or Zarxio. Submit authorization requests for these preferred drugs to AIM. J1447 Tbo-filgrastim Granix® 2020 2020 Use the following preferred filgrastim biosimilar drugs first: Nivestym or Zarxio. Submit authorization requests for these preferred drugs to AIM. J1458 Galsulfase Naglazyme® 2017 2017 4 Medical Drug and Step Therapy Prior Authorization List for Medicare Plus BlueSM and BCN AdvantageSM members Revised September 2021 Prior authorization Submit authorization requirement effective date request through AIM HCPCS Step therapy Medicare BCN Specialty codes Generic name Trade name requirement Plus Blue Advantage NovoLogix® Health® J1459 Immune globulin IV (human), Privigen® 2017 2018 10% liquid J1460 Immune globulin (human), IM GamaSTAN®, 2017 2018 GamaSTAN S/D® J1554 Immune globulin Intravenous Asceniv™ 2019 2019 (human) slra 10% J1555 Immune globulin Subcutaneous Cuvitru® 2020 2020 (Human) 20% J1556 Immune globulin Intravenous Bivigam® 2017 2017 (human), 10% J1557 Immune globulin Intravenous Gammaplex® 2017 2017 (human) J1558 Immune globulin subcutaneous Xembify® 2020 2020 (human)-klhw J1559 Immune globulin Subcutaneous Hizentra® 2017 2017 (human), 20% J1560 Immune globulin (human), IM GamaSTAN®, 2017 2018 (Over 10 mL) GamaSTAN S/D® J1561 Immune globulin Injection Gamunex-C®, 2017 2017 (human), 10% Gammaked™ 5 Medical Drug and Step Therapy Prior Authorization List for Medicare Plus BlueSM and BCN AdvantageSM members Revised September 2021 Prior authorization Submit authorization requirement effective date request through AIM HCPCS Step therapy Medicare BCN Specialty codes Generic name Trade name requirement Plus Blue Advantage NovoLogix® Health® J1566 Immune globulin Intravenous Carimune® 2017 2017 (human) NF, Gammagard S/D® Less IgA J1568 Immune globulin Intravenous Octagam® 2017 2017 (human) J1569 Immune globulin Infusion Gammagard® 2017 2017 (human) 10% Liquid J1572 Immune globulin Intravenous Flebogamma 2017 2017 (human) Dif® J1575 Immune globulin Infusion 10% Hyqvia® 2017 2017 (human) with recombinant human hyaluronidase J1599 Immune globulin subcutaneous Cutaquig® 2020 2020 (human)-hipp J1599 Immune globulin Intravenous Panzyga® 2020 2020 (human) – ifas 10% J1602 Golimumab Simponi Aria® 2017 2018 J1743 Idursulfase Elaprase® 2017 2017 6 Medical Drug and Step Therapy Prior Authorization List for Medicare Plus BlueSM and BCN AdvantageSM members Revised September 2021 Prior authorization Submit authorization requirement effective date request through AIM HCPCS Step therapy Medicare BCN Specialty codes Generic name Trade name requirement Plus Blue Advantage NovoLogix® Health® J1745 Infliximab Remicade® 2017 2017 Use the following preferred infliximab biosimilar drugs: Inflectra or Renflexis. These preferred drugs don’t require authorization. J1746 Ibalizumab-uiyk Trogarzo® 2019 2019 J1786 Imiglucerase Cerezyme® 2017 2017 J1823 Inebilizumab-cdon Uplizna® 2020 2020 J1931 Laronidase Aldurazyme® 2017 2017 J2182 Mepolizumab Nucala® 2018 2017 J2326 Nusinersen Spinraza® 2018 2018 J2357 Omalizumab Xolair® 2018 2018 J2503 Pegaptanib Macugen® 2017 2017 J2505 Pegfilgrastim Neulasta® 2020 2020 J2507 Pegloticase Krystexxa® 2017 2018 J2562 Plerixafor Mozobil® 2020 2020 J2778 Ranibizumab Lucentis® 2017 2017 7 Medical Drug and Step Therapy Prior Authorization List for Medicare Plus BlueSM and BCN AdvantageSM members Revised September 2021 Prior authorization Submit authorization requirement effective date request through AIM HCPCS Step therapy Medicare BCN Specialty codes Generic name Trade name requirement Plus Blue Advantage NovoLogix® Health® J2786 Reslizumab Cinqair® 2018 2017 J2793 Rilonacept Arcalyst® 9/13/2021 9/13/2021 J2796 Romiplostim Nplate® 2017 2018 J2820 Sargramostim Prokine®, 2020 2020 Leukine® J2840 Sebelipase alfa Kanuma® 2019 2017 J2860 Siltuximab Sylvant® 2019 2019 J3032 Eptinezumab-jjmr Vyepti® 2020 2020 Try/fail botulinum toxins AND CGRP antagonists. J3060 Taliglucerase alfa Elelyso® 2017 2017 J3111 Romosozumab-aqqg Evenity® 2019 2019 J3241 Teprotumumab Tepezza® 2020 2020 J3245 Tildrakizumab-asmn Ilumya™ 2019 2019 Try/fail Inflectra or Renflexis. These preferred drugs don’t require authorization. 8 Medical Drug and Step Therapy Prior Authorization List for Medicare Plus BlueSM and BCN AdvantageSM members Revised September 2021 Prior authorization Submit authorization requirement effective date request through AIM HCPCS Step therapy Medicare BCN Specialty codes Generic name Trade name requirement Plus Blue Advantage NovoLogix® Health® J3262 Tocilizumab Actemra® 2017 2017 Try/fail Inflectra or Renflexis. These preferred drugs don’t require authorization. J3285 Treprostinil Remodulin® 2017 2017 J3304 Triamcinolone-acetonide Zilretta® 2019 2019 extended release J3357 Ustekinumab Stelara®SQ 2019 2019 Try/fail Inflectra or Renflexis. These preferred drugs don’t require authorization. J3358 Ustekinumab Stelara®IV 2019 2019 Try/fail Inflectra or Renflexis. These preferred drugs don’t require authorization. 9 Medical Drug and Step Therapy Prior Authorization List for Medicare Plus BlueSM and BCN AdvantageSM members Revised September 2021 Prior authorization Submit authorization requirement effective date request through AIM HCPCS Step therapy Medicare BCN Specialty codes Generic name Trade name requirement Plus Blue Advantage NovoLogix® Health® J3380 Vedolizumab Entyvio® 2017 2018 Try/fail Inflectra or Renflexis. These preferred drugs don’t require authorization. J3385 Velaglucerase alfa VPRIV® 2017 2017 J3397 Vestronidase alfa-vjbk Mepsevii® 2019 2019 J3398 Voretigene neparvovec-rzyl Luxturna® 2018 2018 J3399 Onasemnogene abeparvovec- Zolgensma® 2020 2020 xioi J3490 Avalglucosidase alfa-ngpt Nexviazyme® 9/1/2021 9/1/2021 J3490, Dinutuximab
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