Effective April 1, FasenraTM and Radicava® are subject to a site-of-care requirement for BCN HMOSM members

Effective April 1, 2019, BCN is adding the following medications to its site-of-care optimization program, for BCN HMO (commercial) members only:

Note: This requirement does not apply to BCN AdvantageSM members.

The site-of-care 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.

If a provider feels a member is not a candidate to receive these drugs 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 Fasenra and Radicava must meet applicable authorization criteria in addition to the site-of-care requirement.

For a list of requirements related to drugs covered under the medical benefit, including all drugs identified as subject to a site-of-care requirement, do the following:

  1. Visit the Medical Benefit Drugs – Pharmacy page in the BCN section of this website.

  2. Click Requirements for drugs covered under the medical benefit - BCN HMO and Blue Cross PPO under the heading "For BCN HMO (commercial) members."

The new site-of-care requirement for Fasenra and Radicava will be reflected in the requirements list before the April 1 effective date.

Posted: December 2018
Line of business: Blue Care Network