CommercialPrior AuthMedium impact
Ilumya (J3256) update
Blue Cross Blue Shield of Rhode Island·RI · Dermatology, Rheumatology·Physician / Facility
Effective date
Jul 1, 2024
We identified it
Jun 19, 2026
Summary
Ilumya (J3256) was incorrectly listed as not requiring prior authorization for Commercial members. This drug DOES require prior authorization through Prime Therapeutics for all future requests. Previously denied claims can be reprocessed by contacting Provider services.
Action Required
Immediately: Billing team must obtain prior authorization from Prime Therapeutics for all Ilumya (J3256) claims for Commercial members before billing. Update billing system to flag J3256 as requiring PA. Contact Provider services to have any currently denied authorization claims adjusted and reprocessed.