Reminder: Effective July 1, additional medical benefit drugs for BCN HMO members are subject to a site-of-care requirement

Reminder: Effective July 1, 2017, BCN will add the injectable or infusible drugs listed below to its site-of-care optimization program. This program redirects members receiving these drugs in an outpatient hospital setting to a lower-cost, alternate site of care, such as the physician's office or member's home. This includes members who are currently receiving these drugs and members who are receiving them for the first time.

This requirement applies to Blue Care Network HMOSM (commercial) members. It does not apply to BCN AdvantageSM members.

The drugs are:

As with other drugs in the site-of-care program, if a provider feels a member is not a candidate to receive a drug on this list at a site other than the outpatient hospital, documentation supporting medical necessity must be provided to the plan for review and will be evaluated on a case-by-case basis.

All drugs listed here must meet applicable authorization criteria in addition to the site-of-care requirement.

For additional details, please review the article titled BCN expanding site of care optimization program on July 1, 2017, on page 37 of the May-June 2017 issue of BCN Provider News.

Additional information, including a complete list of drugs in the site-of-care program, is also available on the Medical Benefit Drugs - Pharmacy page in the BCN section of this website. Click Requirements for drugs covered under the medical benefit - BCN HMO under the heading "For BCN HMO (commercial) members." Look for the new July 1 site-of-care requirements in the July 2017 version of the list, which will be available at the end of June.

Posted: June 2017
Line of business: Blue Care Network