07/21/2025

BCBSM/BCN

Recent Oncology Related News

Blue Cross Blue Shield / Blue Care Network Managed Care Committee Members:

Vernell Hester, COC, CHONC - Downriver Oncology Center

Additional Drugs to Require Prior Authorization for Blue Cross Commercial URMBT Members Starting July 30
For dates of service on or after July 30, 2025, the drugs listed below will require prior authorization for Blue Cross commercial UAW Retiree Medical Benefits Trust members. Submit requests as follows.

These requirements apply only when these drugs are administered in an outpatient setting. 

Submit prior authorization requests through the Carelon provider portal or the Medical and Pharmacy Drug PA Portal when these drugs will be billed as a medical benefit.

Note: The requirements don’t apply to the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714).

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Starting Aug. 1, 2025, We’ll Change How We Cover Revlimid
Blue Cross Blue Shield of Michigan and Blue Care Network will change how we cover Revlimid® on the drug lists associated with our prescription drug plans, starting Aug. 1, 2025. This change will affect most Blue Cross and BCN commercial members under the pharmacy benefit.

Brand name Revlimid will no longer be covered for members starting Aug. 1, Instead, we’ll cover the generic equivalent, lenalidomide. If members continue to stay on Revlimid, they’ll be responsible for the full cost. Members can talk to their doctor if they have concerns about this change.

If the member’s pharmacy is unable to fill their prescription with generic lenalidomide, Walgreens Specialty Pharmacy can fill their prescription. Members can call the Walgreens Specialty Pharmacy team at 1-866-515-1355 with questions.

We’ll notify affected members of these changes and encourage them to talk with you about treatment options.

We’re Adding Requirements for Additional Medical Oncology Drugs for Most Members Starting Aug. 20
For dates of service on or after Aug. 20, 2025, we’re adding requirements for the following drugs managed through the Oncology Value Management program, which is administered by OncoHealth.

Note: Site-of-care requirements apply only to commercial members. 

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

These requirements apply when these drugs are administered in outpatient settings for:

• Blue Cross Blue Shield of Michigan commercial and Blue Care Network commercial members
  • All fully insured members (group and individual), with the exception of MESSA members
  • Members who have coverage through self-funded groups that participate in the Oncology Value Management program. Refer to the document titled Oncology Value Management program participation list for self-funded groups.
    
    Note: This requirement doesn’t apply to Blue Cross commercial members who have coverage through the Blue Cross and Blue Shield Federal Employee Program® or through Blue Cross commercial UAW Retiree Medical Benefits Trust plans.
    
    
• Medicare Plus Blue and BCN Advantage members

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