Mepsevii^TM is subject to a site-of-care requirement for BCN HMO^SM (commercial) members

Effective immediately, BCN is adding Mepsevii (vestronidase alfa-vjbk) to its site-of-care optimization program. This program redirects members receiving select drugs in an outpatient hospital setting to a lower-cost, alternate site of care, such as the physician's office or the member's home.

This requirement applies only to Blue Care Network HMO (commercial) members. It does not apply to BCN Advantage^SM members.

If a provider feels a member is not a candidate to receive this drug at a site other than the outpatient hospital, documentation supporting medical necessity must be provided to the plan for review. Those requests will be evaluated on a case-by-case basis. Requests for Mepsevii must meet applicable authorization criteria in addition to the site-of-care requirement.

For additional requirements related to drugs covered under the medical benefit, including all drugs identified as subject to site-of-care requirements, visit the Medical Benefit Drugs – Pharmacy page in the BCN section of this website. Click Requirements for drugs covered under the medical benefit – BCN HMO (PDF) under the heading "For BCN HMO (commercial) members."

The new Mepsevii site-of-care requirement is included in the March 2018 version of the list, which is available now.

Posted: March 2018
Line of business: Blue Care Network