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June 2017
New sites of care pilot program provides options for members to receive infusion services
In June, Blue Cross Blue Shield of Michigan members who are receiving select, specialty drugs in a hospital outpatient facility will start receiving phone calls from Option Care™, one of our home infusion providers. The purpose of these calls is to educate members about the safe options available for moving to home-infusion therapy. In 2017, this is a voluntary program for members. Members aren’t obligated to select Option Care as their provider.
In 2018, we’ll require that members receive infusions in a professional office setting, a professional infusion center or in the member’s home. Additional approval will be required for members to receive infusions in a hospital outpatient department.
This pilot program doesn’t affect the Blue Cross or BCN medical specialty drug prior-authorization program. And the pilot is independent of BCN’s sites of care optimization program requirements.
Specialty drugs targeted for the call program may include:**
Drug |
J codes |
Actemra® (tocilizumab) |
J3262 |
Adagen® (pegademase bovine) |
J2504 |
Aldurazyme® (laronidase) |
J1931 |
Aralast® (alpha-1 proteinase inhibitor) |
J0256 |
Benlysta® (belimumab) |
J0490 |
Bivigam® (IVIG) |
J1556 |
Carimune® NF (IVIG) |
J1566 |
Cerezyme® (imiglucerase) |
J1786 |
Cinryze® (c1 esterase inhibitor) |
J0598 |
Elaprase® (idursulfase) |
J1743 |
Elelyso® (taliglucerase alfa) |
J3060 |
Entyvio® (vedoluzumab) |
J3380 |
Fabrazyme® (afalsidase beta) |
J0180 |
Flebogamma® DIF (IVIG) |
J1572 |
Gammagard Liquid® and Gammagard S/D® (IVIG) |
J1569 |
Gammaplex® (IVIG) |
J1557 |
Gamunex®-C (IVIG) |
J1561 |
Glassia® (alpha-1 proteinase inhibitor) |
J0257 |
Hizentra® (IVIG SC) |
J1559 |
Lumizyme® (aglucosidase alfa) |
J0221 |
Myozyme® (aflucosidase alfa) |
J0220 |
Naglazyme® (galsulfase) |
J1458 |
Octagam® (IVIG) |
J1568 |
Orencia® (abatacept) |
J0129 |
Privigen® (IVIG) |
J1459 |
Prolastin® (alpha-1 proteinase inhibitor) |
J0256 |
Remicade® (infliximab) |
J1745 |
Simponi Aria® (golimumab) |
J1602 |
Soliris® (eculizumab) |
J1300 |
Vpriv® (velaglucerase alfa) |
J3385 |
Zemaira® (alpha-1 proteinase inhibitor) |
J0256 |
Stelara® (usetekinumab) - IV/SC |
J3357 |
Berinert® (c1 esterase inhibitor) |
J0597 |
Firazyr® (icatibant) |
J1744 |
Kalbitor® (ecallantide) |
J1290 |
Xolair® (omalizumab) - SC |
J2357 |
Cimzia® (certolizumab pegol) |
J0717 |
Ilaris® (canakinumab) - SC |
J0638 |
Tysabri® (natalizumab) |
J2323 |
Lemtrada® (alemtuzumab) |
J0202 |
Cinqair® (reslizumab) |
J2786 |
Nucala® (mepolizumab) - SC |
J2182 |
Krystexxa® (pegloticase) |
J2507 |
**Targeted drugs are subject to change. | 