Updated: We're adding site-of-care requirements for Lemtrada and Tysabri for commercial members, starting May 1

We've updated this message, which was first published on Jan. 31, 2020. We added a link to the document Lemtrada and Tysabri site-of-care program: Frequently asked questions by providers, which contains additional program information and details on authorized administration sites in Michigan and elsewhere in the U.S..

Starting May 1, 2020, the medical drug site-of-care program is expanding for Blue Cross' PPO (commercial) and BCN HMO^SM (commercial) members to include:

• Lemtrada^® (alemtuzumab, HCPCS code J0202)
• Tysabri^® (natalizumab, HCPCS code J2323)

Through April 30, 2020, members who receive these drugs in one of the following locations are authorized to continue treatment:

• Doctor's office or other health care provider's office
• Ambulatory infusion center
• Hospital outpatient facility

Starting May 1, 2020, infusions of Tysabri and Lemtrada may not be covered at hospital outpatient facilities.* Before May 1, members should talk to their doctors to make arrangements to receive infusion services at one of the following locations:

• Doctor's office or other health care provider's office
• Ambulatory infusion center

*Based on Risk Evaluation and Mitigation Strategies, or REMS, program restrictions, administration of Lemtrada and Tysabri is limited to authorized locations. For Lemtrada, we'll restrict transitions to select locations that have safety protocols in place for adverse reactions. To aid in member transition, please refer to the document Lemtrada and Tysabri site-of-care program: Frequently asked questions by providers, which contains additional program information and details on authorized administration sites in Michigan and elsewhere in the U.S..

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 the Federal Employee Program^® Service Benefit Plan members.

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 our ereferrals.bcbsm.com website:

• The Blue Cross Medical Benefit Drugs - Pharmacy webpage
• The BCN Medical Benefit Drugs - Pharmacy webpage

We've updated the requirements list with the new information about Lemtrada and Tysabri.