Blue Cross updates policy for medical specialty drug infusions

Beginning Jan. 1, 2018, Blue Cross Blue Shield of Michigan will require prior authorization to cover infusions of select specialty drugs administered in the hospital outpatient department. Members must instead receive their infusions in a professional office setting, a professional infusion center or in the member’s home.

All drugs included in this program already require prior authorization for payment. Approved authorizations will be payable at professional settings and through home infusion with no further action required. An updated review for medical necessity will be required for members to receive infusions in a hospital outpatient facility.

Updated medical necessity review
If a member must receive his or her infusion in a hospital outpatient facility, please follow the normal steps for a prior authorization request and include the:

• Authorization number previously approved
• Rationale that clearly describes the reason that the infusion must be administered in a facility setting
• Supporting chart notes

Specialty drugs subject to this requirement include: