Datroway (datopotamab deruxtecan-dlnk) — Prior authorization for outpatient medical administration
This provider alert announces that Datroway (datopotamab deruxtecan-dlnk), HCPCS J9011, will require prior authorization through the Oncology Value Management program for covered members receiving the drug under the medical benefit in outpatient settings starting Dec. 1, 2025.
Datroway (datopotamab deruxtecan-dlnk), HCPCS code J9011, will require prior authorization through the Oncology Value Management program for dates of service on or after Dec. 1, 2025.
Coverage Criteria
Prior authorization applicability
Prior authorization through Oncology Value Management is required for Datroway when ALL of the following apply:
PA applicability
- Applicable member groups: Applies to: all Blue Cross Blue Shield of Michigan and Blue Care Network commercial fully insured members (group and individual) except MESSA; members covered through self-funded groups that participate in the Oncology Value Management program; all members with individual coverage; Medicare Plus Blue and BCN Advantage members.
This requirement does not apply to Blue Cross commercial members covered through the Blue Cross and Blue Shield Federal Employee Program or through Blue Cross commercial UAW Retiree Medical Benefits Trust plans.
The prior authorization requirement does not apply to Blue Cross commercial members covered through the Blue Cross and Blue Shield Federal Employee Program or through Blue Cross commercial UAW Retiree Medical Benefits Trust plans. Additionally, MESSA members are excluded from the fully insured member requirement. Refer to the Oncology Value Management program participation list for self-funded groups that participate and therefore are subject to the requirement.
For dates of service on or after Dec. 1, 2025, prior authorization through the Oncology Value Management program administered by OncoHealth is required for Datroway (datopotamab deruxtecan-dlnk), HCPCS code J9011, when administered under the medical benefit in outpatient settings. This applies to Blue Cross Blue Shield of Michigan and Blue Care Network commercial fully insured members (except MESSA), members with individual coverage, Medicare Plus Blue and BCN Advantage members, and members of self-funded groups that participate in the Oncology Value Management program.
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