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February 2018

Starting March 1, 2018, prescriptions for all growth hormone products will have mandatory prior authorization requirements

At Blue Cross Blue Shield of Michigan and Blue Care Network, we regularly review drug therapies as an extra safeguard to ensure we cover the right medication for the right situation.

Beginning March 1, 2018, growth hormone products will require approval before Blue Cross and BCN will cover them under their prescription drug plan.

A few points to remember

  • Drug approval requirements for coverage and all drug lists can be found online at bcbsm.com/pharmacy.
  • Pediatric members and adult members have different coverage requirements.
  • We cover nonpreferred growth hormone products after the member tries all preferred products and finds them not effective.

Here’s the copayment levels for growth hormone products:

Higher cost (nonpreferred) drugs

Copayment level

3-tier benefit

4-tier benefit

5-tier and 6-tier benefits

Humatrope®

Nonpreferred brand
(tier 3)

Specialty
(tier 4)

Nonpreferred specialty
(tier 5)

Omnitrope®

Saizen®, Saizenprep®

Serostim®

Zomacton™

Lower cost (preferred) alternatives

3-tier benefit

4-tier benefit

5-tier and 6-tier benefits

Genotropin®

Preferred brand
(tier 2)

Specialty
(tier 4)

Preferred specialty
(tier 4)

Norditropin® FlexPro®
(will be preferred effective March 1, 2018)

Nutropin AQ® Nuspin™

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.