Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
BCBS MichiganCommercial · Prior Auth · Specialty Services · MI · OncologyHigh impact

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

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.

Get alerts when payers change rules like this one

We check BCBS Michigan and other payers every day and email you when a change matches your specialty and state.

Get BCBS Michigan alertsPolicy Monitoring is free. No card required.

What to do

by May 13, 2026 · 5 steps
01Billing team must update systems to require prior authorization for oncology HCPCS codes J9184, J9054, J9183, J9277, J9278, J9601, J9056, and J9028.
02Submit prior auth requests to OncoHealth at 1-888-916-2616 or through OncoHealth Provider Portal.
03Update step therapy protocols for Anktiva (J9028) to require failure of both Adstiladrin (J9029) and Keytruda (J9271 or J9277).
04Note that Lynozyfic (J9601) requires prior auth and site of care approval but NO step therapy.
05Claims without proper authorization will be denied.

Codes mentioned

J9184J9054J9183J9277J9278J9601J9056J9028J9029J9271

Original notice

We’re adding requirements for additional medical oncology drugs for most members, starting May 13
bcbsm.com · Always check the source before changing claims.
View original ↗

Related changes

See all BCBS Michigan changes →
Correction: 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

Related policy hubs

BCBS Michigan policiesMI policy changesOncologyCode J9184Code J9054Code J9183Code J9277Code J9278Code J9601Code J9056Code J9028Code J9029Code J9271

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account