Uplizna^™ will have authorization and site-of-care requirements for commercial members effective August and October 2020

We're adding authorization and site-of-care requirements for Uplizna (inebilizumab-cdon, HCPCS code J3590), a specialty drug covered under the medical benefit, for BCN HMO^SM (commercial) and Blue Cross' PPO (commercial) members:

• For BCN HMO members: Uplizna will require authorization and have site-of-care requirements for members who begin therapy on or after Aug. 1, 2020.
• For Blue Cross' PPO members: Uplizna will require authorization for members who begin therapy on or after Oct. 1, 2020.

More about the authorization requirements

The authorization requirements apply only to groups that currently participate 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, which is available from these pages this website:

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

We'll update the requirements list with this information prior to each effective date.

Posted: July 2020
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network