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Correction: We’re adding requirements for additional medical oncology drugs for most members, starting May 13
Act
by May 13, 2026
Effective date
May 13, 2026
Identified
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.
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What to do
by May 13, 2026 · 5 steps
01Billing team must update system to require prior authorization for HCPCS codes J9184, J9054, J9183, J9277, J9278, J9601, J9056, and J9028.
02Submit prior auth requests to OncoHealth at 1-888-916-2616 or through the OncoHealth Provider Portal.
03For Adstiladrin (J9029), submit to Blue Cross/BCN.
04Update encounter forms to alert providers about new step therapy requirements for Anktiva.
05Claims without prior authorization will be denied.
Codes mentioned
J9184J9054J9183J9277J9278J9601J9056J9028J9029J9271
Original notice
Correction: We’re adding requirements for additional medical oncology drugs for most members, starting May 13
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 · CodingAdditional medical benefit drugs will require prior authorization for Blue Cross commercial URMBT membersMediumEffective Jul 1, 2026 · Prior AuthorizationHCPCS replacement codes established, effective April 1, 2026MediumEffective Apr 1, 2026 · CodingBrowse every BCBS Michigan change in the policy list