Some drugs not payable when administered by a health care professional to Blue Cross and BCN commercial members, starting April 1

For dates of service on or after April 1, 2021, the medications listed in this message will not be payable by Blue Cross Blue Shield of Michigan and Blue Care Network when administered by a physician or other health care professional.

Currently, these drugs are payable under either the medical benefit or the pharmacy benefit. Starting April 1, these drugs are payable under only the pharmacy benefit.

Reason for the change

The drugs listed in this message can safely and conveniently be self-administered in the member's home and do not require administration by a health care professional.

Drugs affected by this change

Here are the drugs that are subject to this change:

There are no other changes that apply to the management of these therapies at this time.

Lists of requirements

To view requirements for drugs covered under the pharmacy benefit, see the Blue Cross and BCN Prior authorization and step therapy coverage criteria (PDF) document. This document is available from the following pages on this website:

For a list of requirements related to drugs covered under the medical benefit, see the Blue Cross and BCN utilization management medical drug list for Blue Cross PPO (commercial) and BCN HMO (commercial) members document.

We'll update the requirements lists with the new information prior to April 1, 2021.

Posted: December 2020
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network