Effective July 1, 2023, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will have changes to our medical utilization management (UM) requirements under the medical benefit for the commercial line of business. Blue Cross NC is adding new drugs that require review and authorization. Effective July 1, 2023, Blue Cross NC is expanding its UM requirements to include the medications listed below:

• J1952 – leuprolide mesylate (Camcevi^™)
• J9217 – leuprolide acetate (Eligard^®)
• J1951 – leuprolide acetate (Fensolvi^®)
• J1950, J9217 – leuprolide acetate for depot suspension (Lupron Depot Kit^®)
• J1954 – leuprolide acetate for depot suspension (generic Leuprolide Depot)
• J1950 – leuprolide acetate for depot suspension (Lupron Depot-Ped Kit^®)
• J9226 – histrelin acetate (Supprelin^® LA)
• J3315 – triptorelin pamoate (Trelstar^®)
• J3316 – triptorelin pamoate (Triptodur^®)
• J9202 – goserelin acetate (Zoladex^®)

Any new or renewal authorization requests for the provider-administered medications applicable to this policy will not be eligible for reimbursement under Blue Cross NC members’ benefits, unless approved in advance by Blue Cross NC. More details can be found here.

Actions for Providers: 

Please review these new requirements and work with the Blue Cross NC patients who currently receive these medications before July 1, 2023, if any changes in their medications are necessary. For those Blue Cross NC patients who meet utilization management criteria to continue on this medication, you will need to provide additional information to Blue Cross NC.

Requests may be submitted to Blue Cross NC electronically via CoverMyMeds^™, our free online prior authorization tool for prescriptions. If you do not have online access, you can still submit requests by fax to the number listed at the bottom of the fax form, by the signature box.

If you have questions, please call our Provider Blue Line^℠ at 800-214-4844 for assistance.

These changes apply to the following lines of business: Administrative Services Only (ASO), commercial fully insured membership, Blue Card IPP Host and the State Health Plan (SHP). These changes do not affect Federal Employee Program or Medicare members.