We're adding drugs to prior authorization, site of care programs for PPO members, effective October 2019

Starting Oct. 1, 2019, the Medical Drug Prior Authorization and Site of Care programs are expanding for Blue Cross commercial members. These changes don't apply to Medicare Plus Blue PPO^SM or Federal Employee Program^® members.

Prior authorization requirements

For members initiating therapy on or after Oct. 1, 2019, you must request authorization for these drugs:

• Lemtrada^® (alemtuzumab, HCPCS code J0202)
• Ocrevus^® (ocrelizumab, HCPCS code J2350)
• Tysabri^® (natalizumab, HCPCS code J2323)

Ocrevus will also be added to the Site of Care Program, effective Oct. 1, 2019. We'll publish more information on this subject in the August issue of The Record.

More about authorization requirements

The authorization requirements apply only to groups that are currently participating in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit.

A prior authorization approval isn't a guarantee of payment. Health care practitioners need to verify eligibility and benefits for members.

List of requirements

For a list of requirements related to drugs covered under the medical benefit, please click here.

You can also visit the Drugs Covered Under the Medical Benefit page on this website.

The requirements that take effect on Oct. 1 will be reflected in the requirements list before that date.

Posted: July 2019
Line of business: Blue Cross Blue Shield of Michigan