Blue Cross won’t cover 4 more infusion drugs at outpatient hospital sites without approval, starting July 1

Beginning July 1, 2018, Blue Cross Blue Shield of Michigan is adding four drugs to its infusion site of care requirement for groups currently participating in the commercial Medical Drug Prior Authorization Program:

Blue Cross won’t cover infusions for these drugs at a hospital outpatient facility without a prior authorization for that approved location. If the member now receives his or her infusions in a professional location (such as a physician’s office or an approved infusion center) or the patient’s home, the only requirement is approval of the drug.

Help your patient switch his or her infusion therapy location by July 1

If your patient gets one of these drug infusions in a hospital outpatient facility, follow these steps to switch him or her to your office, an infusion center or home:

1. Submit your patient’s prior approval request to Blue Cross. If this request isn’t submitted and approved, he or she will be responsible for the full cost of the medicine.
2. Find out where your patient can continue infusion therapy. Check the directory of participating home infusion therapy providers and infusion centers.
3. Tell your patient to contact any in-network infusion therapy providers (we’re sending this information to your patient as well). If the chosen provider can accommodate your patient, they’ll work with you and your patient to make the change easy.
4. Confirm network participation for your patient before his or her infusion.

If a patient must receive one of these infusions in a hospital outpatient facility, follow the normal steps for a prior authorization request and include:

• The previously approved authorization number
• Clear rationale describing the reason the infusion must be administered in a hospital setting
• Supporting chart notes

For more information about hospital outpatient infusion therapy, view our previous October 2017, December 2017 and March 2018 articles in The Record.