Coverage for some infertility treatment drugs will change, starting April 1

As part of our commitment to providing our members with safe, high-quality, cost-effective prescription drugs, we’re making some changes to our drug coverage.

Starting April 1, 2019, Blue Cross Blue Shield of Michigan and Blue Care Network will make coverage changes for some infertility treatment drugs as follows:

Drug

Standard coverage changes

Covered preferred alternative

Endometrin^®

Needs prior approval
Member cost: Nonpreferred brand copayment
If coverage requirements aren’t met, the member may be responsible for the full cost.

Crinone^® 8%
Member cost: Preferred brand copayment

Ganirelix Acetate

No longer covered
Member cost: Full cost

Cetrotide^®
Member cost: If member has a benefit with specialty tiers, preferred brand copayment or preferred specialty copayment

Members with an approved prior authorization can continue to fill their prescriptions until the prior authorization end date but may have a higher copayment.

We notified affected members of these changes and encouraged them to discuss treatment options with their doctors.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.