Effective Jan. 1, 2020, Eylea® and Lucentis® will require authorization for Blue Cross' PPO (commercial) members
Effective Jan.1, 2020, you'll have to obtain authorization before Blue Cross' PPO (commercial) members begin receiving the following drugs:
The authorization requirement applies to all Blue Cross' PPO members who start receiving these therapies on or after Jan. 1. This requirement applies only to groups that currently participate in the commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit.
To facilitate continuity of care, members who start therapy before Jan. 1 won't be required to obtain authorization to continue therapy.
Note: These drugs currently require authorization for BCN HMOSM (commercial), BCN AdvantageSM and Medicare Plus BlueSM PPO members.
This requirement doesn't apply to Blue Cross' PPO members covered under the Federal Employee Program® Service Benefit Plan.
Authorization isn't a guarantee of payment. Health care providers 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 see the Requirements for drugs covered under the medical benefit - BCN HMO and Blue Cross PPO document located in the Medical Benefit Drugs - Pharmacy section of this website.
The authorization requirement for Eylea and Lucentis will be reflected in the requirements list on Jan. 1, 2020.
Posted: September 2019
Line of business: Blue Cross Blue Shield of Michigan