We're adding two medical drugs to the site-of-care program for Blue Cross and Blue Care Network commercial members starting April 1, 2020

The site of care program for specialty drugs covered under the medical benefit is expanding starting April 1, 2020. This applies to Blue Cross' PPO (commercial) and BCN HMO^SM (commercial) members for the following drugs:

• Hemlibra^® (emicizumab-kxwh, HCPCS code J7170)
• Onpattro^® (patisiran, HCPCS code J0222)

What to do by April 1

Before April 1, 2020, providers should encourage commercial members to select one of the following infusion locations instead of an outpatient hospital facility:

• A doctor's or other health care provider's office
• An ambulatory infusion center
• The member's home, from a home infusion therapy provider

If members currently receive infusions for these drugs at a hospital outpatient facility, providers must:

• Obtain prior authorization for that location
• Check the directory of participating home infusion therapy providers and infusion centers to see where the member may be able to continue infusion therapy

If the infusion therapy provider can accommodate the member, they'll work with the member and the member's practitioner to make this change easy. The member may also contact the ordering practitioner directly for help with the change.

More about the authorization requirements

The authorization requirements apply only to groups that are currently participating in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. These changes don't apply to members covered by the Federal Employee Program^® Service Benefit Plan.

Authorization isn't a guarantee of payment. Health care practitioners 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 on this website:

• The Blue Cross Medical Benefit Drugs - Pharmacy webpage
• The Blue Care Network Medical Benefit Drugs - Pharmacy webpage

We'll update the requirements list for these drugs prior to April 1.