Most immune globulin infusions will not be covered at outpatient hospital facilities starting April 1, 2018

Beginning April 1, 2018, Blue Cross Blue Shield of Michigan will require prior authorization for members who seek infusions or are currently receiving infusions in a hospital outpatient facility for select immune globulin medical drugs prior to being administered. Members must 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.

If your patient currently receives IVIG infusions at a hospital outpatient facility:

• Submit a prior approval request for your patient to Blue Cross for a hospital outpatient facility. If this request isn’t submitted and approved, the patient will be responsible for the full cost of the medicine.
• Check the directory of participating home infusion therapy providers and infusion centers where your patient may be able to continue infusion therapy.
• Tell your patient to contact any of the listed infusion therapy providers. If they’re able to accommodate your patient, they will work with your patient and you to make this change easy. We’re also sending this information to your patient.
• Help your patient switch infusion therapy to your office, infusion center or home infusion therapy provider by April 1.

For the ordering provider:
If a member must receive IVIG 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 the infusion must be administered in a hospital setting
• Supporting chart notes

The IVIG drugs subject to this requirement include:

Note: A new authorization is not required when a member changes to a different IVIG product and an active prior authorization is already approved for the location where the infusion will be administered.

For more information about hospital outpatient infusion therapy, view the previous articles in the October and December issues of The Record.