Medicare AdvantagePrior AuthHigh impact
Pharmacy news roundup
BCBS Michigan·MI · Pharmacy, Oncology, Radiation Oncology·Pharmacy
We identified it
Jun 26, 2026
Summary
This is a pharmacy news roundup from Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) summarizing multiple pharmacy-related policy changes effective between June and September 2026. Key changes include: prior authorization requirements for Immgolis Intri IV (June 1), additional drugs for Medicare Advantage (July 1), CGM product eligibility verification for University of Michigan employers, radiopharmaceutical management through oncology programs (Sept 1), and new medical oncology drug requirements (Aug 12). Practices must review each linked alert for specific billing code impacts.
Action Required
By July 31, 2026: Billing and clinical teams must immediately access BCBSM provider portal (availity.com) and review all linked pharmacy alerts to identify specific CPT/HCPCS codes affected. For each alert: (1) Update billing system to enforce prior authorization requirements for affected drugs; (2) Modify encounter templates to prompt providers to obtain prior auth before prescribing; (3) For CGM products prescribed to University of Michigan members—verify eligibility and benefits before processing; (4) For Medicare Advantage members—implement prior auth for Immgolis Intri IV (effective June 1) and additional drugs (effective July 1); (5) For medical oncology drugs—update system rules by August 12; (6) Coordinate with oncology department regarding radiopharmaceutical management transition (Sept 1). Subscribe to Provider Alerts Weekly (link provided) to receive ongoing updates. Failure to implement these changes will result in claim denials and delayed reimbursement.