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Additional medical benefit drugs will require prior authorization for Blue Cross commercial URMBT members
Effective date
Jul 1, 2026
Identified
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.
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What to do
Action · 4 steps
01Before 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.
02Configure billing system to flag these codes for prior auth requirement.
03Train staff to submit requests through Carelon Medical Benefits Management provider portal or Medical and Pharmacy Drug PA Portal via Availity.
04Claims will be denied without proper prior authorization.
Codes mentioned
J9183J9277J9278J9601J7356
Original notice
Additional medical benefit drugs will require prior authorization for Blue Cross commercial URMBT members
bcbsm.com · Always check the source before changing claims.
Related changes
See all BCBS Michigan changes →We’re adding requirements for additional medical oncology drugs for most members, starting May 13HighEffective May 13, 2026 · Specialty ServicesHCPCS 1st-quarter update: New, deleted codesHighEffective Apr 1, 2026 · CodingCorrection: We’re adding requirements for additional medical oncology drugs for most members, starting May 13HighEffective May 13, 2026 · Specialty ServicesHCPCS replacement codes established, effective April 1, 2026MediumEffective Apr 1, 2026 · CodingBrowse every BCBS Michigan change in the policy list