Immune, subcutaneous globulin dosing strategy changing

Blue Cross Blue Shield of Michigan and Blue Care Network currently include immune globulin products in the prior authorization program under pharmacy and medical benefits for commercial members. Intravenous and subcutaneous immune globulin products available for the medical benefit are also included in the site of care program.

Immune globulin replacement therapy is indicated for many labeled and off-label indications and is traditionally dosed using a patient’s actual body weight. IVIG and SCIG products (see the list below) have insignificant distribution into fat tissue and are only present in the intravascular space and extracellular fluids. Clinical literature supports alternative dosing strategies that provide comparable drug exposure without altering the clinical outcomes of treatment.

To minimize drug waste, reduce unnecessary drug exposure and decrease the risk of adverse events, we’ll update our dosing strategy for intravenous and subcutaneous immune globulin therapy.

Effective Oct. 1, 2019, we’ll calculate doses using adjusted body weight for members whose:

• Body mass index is 30 kg/m2 or greater, or
• Actual body weight is 20% to 30% higher than their ideal body weight.

This applies to all members starting therapy on or after Oct. 1. Members currently receiving immune globulin will continue to receive their current dose until their prior authorizations expire.

This change doesn’t apply to the following:

• Blue Cross PPO or BCN HMO^SM commercial pediatric members, defined as:
  • Less than or equal to 15 years of age, or
  • Less than or equal to 18 years old and less than or equal to 50 kg.
• BCN Advantage^SM members
• Medicare Plus Blue^SM PPO members
• Federal Employee Program^® members

We’ll contact members currently on IVIG and SCIG therapy to let them know about this change.