Select infusion drugs have new requirements for site of administration starting Oct. 1, 2015
Many injectable or infusible drugs covered under Blue Care Network members' medical benefit can be safely and effectively administered at several different sites of care. The most common sites include the outpatient hospital, physician's office and the member's home.
To help manage the cost of these drugs, BCN is implementing a program that redirects patients receiving select infusion drugs in the hospital setting to alternate sites of care.
Starting Oct. 1, 2015, BCN commercial members who begin therapy with one of the following drugs or drug categories will be required to receive this therapy at an infusion center, at their physician's office or at home.
- Alpha-1 antitrypsin inhibitors (for example, Prolastin®)
- Immune globulin therapy (for example, Gammagard®)
- Lysosomal storage therapy (for example, Cerezyme®)
- Soliris®
BCN is also reaching out to members currently being treated with these therapies and their physicians to encourage members to use a more cost-effective site of care, such as an infusion center, their physician's office or their home.
The BCN Referral/Clinical Review Program document will be updated by October 1 to reflect this new requirement. That document is available on this website, on the Clinical Review & Criteria Charts page.