CommercialPrior AuthMedium impact
Additional medical benefit drugs will require prior authorization for Blue Cross commercial URMBT members
BCBS Michigan·MI · Oncology, Neurology·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jun 16, 2026
Summary
Starting July 1, 2026, six specific drugs (including Keytruda Qlex, Inlexzo, and others) will require prior authorization for Blue Cross commercial UAW Retiree Medical Benefits Trust members when administered in outpatient settings. Authorization requests must be submitted through designated portals before administration.
Action Required
Before July 1, 2026: Billing team must update prior authorization workflows for HCPCS codes J9183, J9277, J9278, J9601, and J7356 for Blue Cross commercial URMBT members. Configure billing system to flag these codes for prior auth requirement. Train staff to submit requests through Carelon Medical Benefits Management provider portal or Medical and Pharmacy Drug PA Portal via Availity. Claims will be denied without proper prior authorization.