Effective Nov. 1, Blue Cross and BCN will have preferred hereditary angioedema medications for our commercial members

Currently, all hereditary angioedema, or HAE, medications require prior authorization for Blue Cross and Blue Care Network commercial members. Effective Nov. 1, 2020, Blue Cross and BCN will have preferred medications for HAE therapy for those members.

This means that:

• We'll require our commercial members to use preferred HAE drugs for acute treatment and for preventive therapy that begins on or after Nov. 1, 2020.
• For commercial members currently receiving a nonpreferred HAE drug:
  • These members are authorized to continue their current therapy until through Oct. 31, 2020.
  • We've proactively authorized therapy with the preferred medications from Nov. 1, 2020, through Oct. 31, 2021, to avoid any interruptions in care.
  • We encourage you to discuss any concerns members may have as they transition to the preferred medications.

We'll be mailing letters to impacted members to notify them of these changes.

These changes apply to all Blue Cross' PPO and BCN HMO^SM members.

Note: For HAE therapy covered under the medical benefit, the requirements outlined in this message apply only to groups that are currently participating in the standard commercial Medical Drug Prior Authorization Program. Proactive authorizations for preferred therapy on the pharmacy benefit apply to members who have their pharmacy benefit with Blue Cross Blue Shield of Michigan or Blue Care Network.

Which medications are preferred?

Here's what you need to know about the medications:

For acute HAE treatment

• Preferred medication: Icatibant (HCPCS code J1744)
• Nonpreferred medications:
  • Firazyr^® (brand icatibant, HCPCS code J1744)
  • Berinert^® (c1 esterase inhibitor, human, HCPCS code J0597)
  • Kalbitor^® (ecallantide, HCPCS code J1290)
  • Ruconest^® (c1 esterase inhibitor, recombinant, HCPCS code J0596)

For HAE prevention

• Preferred medications:
  • Haegarda^® (c1 esterase inhibitor, human)
  • Takhzyro^® (lanadelumab-flyo)
• Nonpreferred medication: Cinryze^® (c1 esterase inhibitor, human, HCPCS code J0598)

Additional information

For additional information on requirements related to drugs for our commercial members, see:

• Requirements for drugs covered under the medical benefit (PDF)
• Requirements for drugs covered under the pharmacy benefit (PDF)