CommercialPrior AuthHigh impact
Correction: We’re adding requirements for additional medical oncology drugs for most members, starting May 13
BCBS Michigan·MI · Oncology·Specialty Services
Effective date
May 13, 2026
We identified it
Jun 16, 2026
Summary
Blue Cross Blue Shield of Michigan is adding prior authorization, site of care, and step therapy requirements for seven medical oncology drugs effective May 13, 2026. The policy also updates step therapy requirements for Anktiva to require trying two drugs instead of one.
Action Required
By May 13, 2026: Billing team must update system to require prior authorization for HCPCS codes J9184, J9054, J9183, J9277, J9278, J9601, J9056, and J9028. Submit prior auth requests to OncoHealth at 1-888-916-2616 or through the OncoHealth Provider Portal. For Adstiladrin (J9029), submit to Blue Cross/BCN. Update encounter forms to alert providers about new step therapy requirements for Anktiva. Claims without prior authorization will be denied.