Updated: Palforzia^™ and Tepezza^™ will have authorization and site-of-care requirements for commercial members effective March and May 2020

We updated this message to correct the HCPCS code for Palforzia.

We're adding authorization and site-of-care requirements for specialty drugs covered under the medical benefit for Blue Cross' PPO (commercial) and BCN HMO^SM (commercial) members for the following drugs:

• Palforzia (peanut [Arachis hypogaea] allergen powder-dnfp, HCPCS code J3590)
• Tepezza (teprotumumab-trbw, HCPCS code J3590)

For BCN HMO members

• We'll require authorization for Palforzia and Tepezza for members who begin therapy on or after March 1, 2020.
• We'll add Tepezza to the site-of-care program for BCN HMO members effective March 1, 2020.

For Blue Cross' PPO members

We'll require authorization for Palforzia and Tepezza for members who begin therapy on or after May 1, 2020.

More about the authorization requirements

These 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 Blue Cross and BCN utilization management medical drug list for Blue Cross PPO (commercial) and BCN HMO (commercial) members (PDF) document on this website:

• Blue Cross Medical Benefit Drugs - Pharmacy page
• BCN Medical Benefit Drugs - Pharmacy page

We'll update the requirements list for the drugs listed above prior to the effective dates for the changes.