CommercialPrior AuthHigh impact
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
Starting May 13, 2026, Blue Cross Blue Shield of Michigan and Blue Care Network are adding prior authorization, site of care, and step therapy requirements for 7 medical oncology drugs administered in outpatient settings. Additionally, step therapy requirements for Anktiva are being expanded to require failure of two drugs instead of one.
Action Required
By May 13, 2026: Billing team must update systems to require prior authorization for oncology HCPCS codes J9184, J9054, J9183, J9277, J9278, J9601, J9056, and J9028. Submit prior auth requests to OncoHealth at 1-888-916-2616 or through OncoHealth Provider Portal. Update step therapy protocols for Anktiva (J9028) to require failure of both Adstiladrin (J9029) and Keytruda (J9271 or J9277). Note that Lynozyfic (J9601) requires prior auth and site of care approval but NO step therapy. Claims without proper authorization will be denied.