BCBSM, BCN place new restrictions on testosterone for commercial drug coverage

The Blues will no longer cover most testosterone products for female members who have Blue Cross Blue Shield of Michigan commercial (non-Medicare) prescription drug coverage.

Commercial Blue Care Network plans and all qualified health plans already have such a restriction in place. The affected drugs haven’t been tested for safety or effectiveness by the U.S. Food and Drug Administration for use by females.

Further, both BCBSM and BCN will require prior authorization for male members to receive coverage for these drugs, if their plan requires it.

For BCBSM members, both changes are effective April 1, 2014. The affected drugs are: 

For commercial BCN members, the restrictions apply to all testosterone products.

BCN will authorize continued use for six months for male members who currently use one of these products. This authorization will allow physicians to evaluate members who currently use the therapy to determine where the member meets BCN criteria for approval.

This is part of our ongoing efforts to promote cost-effective, high-quality prescription drug therapy.
These changes do not apply to members of BCBSM Michigan Education Special Services Association plans and all Medicare Advantage plans or Medicare Part D plans. We’ll notify affected members of these changes and encourage them to contact their physicians to discuss other treatment options.

BCBSM and BCN drug lists can be found at bcbsm.com/rxinfo.