CommercialPrior AuthHigh impact
We’re adding requirements for additional medical oncology drugs for most members, starting Aug. 12
BCBS Michigan·MI · Oncology, Hematology·Specialty Services
Effective date
Aug 12, 2026
We identified it
Jun 26, 2026
Summary
Blue Cross Blue Shield of Michigan is adding prior authorization, site of care, and step therapy requirements for 7 medical oncology drugs administered in outpatient settings, effective August 12, 2026. These drugs are managed through the Oncology Value Management program and affect commercial, Medicare Advantage, and individual plan members. Billing teams must implement new prior authorization submission workflows to OncoHealth and update internal systems to reflect these requirements before the effective date.
Action Required
By August 12, 2026: Billing team must implement prior authorization requirements for 7 medical oncology drugs (Armlupeg Q51691, Blenrep J90531, Cyramza J9308, Frindovyx J9072, Rybrevant Faspro J90621, Yartemlea J1289, Yondelis J9352) administered in outpatient settings. Update billing software to require prior authorization submission to OncoHealth (1-888-916-2616 or OncoHealth Provider Portal) for all commercial BCBS Michigan, BCN, Medicare Plus Blue, and BCN Advantage members. Configure system to enforce site of care requirements for applicable drugs and implement step therapy logic, particularly for Yondelis (requires Halaven J9179 trial/failure first for liposarcoma treatment). Update encounter forms and provider documentation templates to prompt for medical necessity documentation. For Yartemlea, transition prior authorization requests from the Medical and Pharmacy Benefit Drug Prior Auth Portal to OncoHealth effective August 12. Verify eligibility and benefits for all members before service delivery. Claims submitted without required prior authorization will be denied. Reference updated Medical Oncology Prior Authorization Lists for BCBS/BCN commercial and Medicare Advantage members before August 12.