Effective July 1, KhapzoryTM and Fusilev® will be added the prior authorization program for PPO commercial members.
Effective July 1, 2019, KhapzoryTM and Fusilev® will be added to the Medical Drug Prior Authorization Program for Blue Cross Blue Shield of Michigan PPO commercial members. This applies to any members starting therapy on or after July 1.
These drugs are currently included in the prior authorization program for Blue Care Network HMOSM commercial members.
The authorization requirement only applies to groups that are currently participating in the commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. These changes don't apply to BCN AdvantageSM, Blue Cross Medicare Plus BlueSM PPO or Federal Employee Program® members.
A prior authorization approval isn't a guarantee of payment. Health care practitioners need to verify eligibility and benefits for members. Members are responsible for the full cost of medications not covered under their medical benefit coverage.
For a list of requirements related to drugs covered under the medical benefit, do the following:
The new prior authorization requirement for Khapzory and Fusilev will be reflected in the requirements list before the July 1 effective date.
Posted: March 2019
Line of business: Blue Cross Blue Shield of Michigan