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December 2019
New quantity limits, authorization requirement coming for ketoprofen for PPO, HMO commercial members
The following changes are coming for Blue Cross Blue Shield of Michigan and BCN HMOSM commercial members:
- New courses of treatment involving ketoprofen 25 mg that begin on or after Dec. 1, 2019, require authorization. If you don’t obtain authorization, your patient may be responsible for the full cost of the drug.
- Effective March 1, 2020, ketoprofen 25 mg will be limited to four capsules per day or 120 capsules per 30 days. Requests to cover larger quantities will need to include documentation showing that the larger quantity is medically necessary.
Members who start taking ketoprofen prior to Dec. 1, 2019, can continue their treatment courses. However, as of March 1, 2020, you’ll need to secure authorization for these members to continue therapy.
Keep in mind that authorization isn’t a guarantee of payment. You can verify eligibility and benefits through web-DENIS.
We’ll notify affected members of these changes and encourage them to talk to their providers if they have concerns.
Note: These requirements don’t apply to Medicare Plus BlueSM or BCN AdvantageSM members. |
