Skyrizi and Tegsedi covered under pharmacy benefit for Blue Cross and BCN commercial members

We’re changing how we cover Skyrizi^® and Tegsedi^® for our Blue Cross Blue Shield of Michigan and Blue Care Network commercial members. As of Oct. 8, 2020, our Blue Cross and BCN commercial plans no longer cover the following medications under the medical benefit but will cover them under the pharmacy benefit:

• Skyrizi (risankizumab-rzaa), HCPCS codes C9399, J3590
• Tegsedi (inotersen), HCPCS codes C9399, J3490

Coverage for these drugs is moving to the pharmacy benefit because they can be safely and conveniently self-administered in the member’s home. We'll contact members and advise them to talk to their doctor about prescribing these medications for purchase from a pharmacy.

These drugs are available through pharmacies that dispense specialty drugs, including AllianceRx Walgreens Prime Specialty Pharmacy. Health care providers who administer these medications to their patients on or after Oct. 8, 2020, will be responsible for the cost.

There are no changes to how these therapies should be managed.

• Both Skyrizi and Tegsedi will continue to require prior authorization. (See more information on submitting prior authorization requests below.)
• For Skyrizi, quantity limits continue to apply.
• For Tegsedi, documentation requirements continue to apply.

Submitting prior authorization requests

Providers can submit prior authorization requests for these drugs as follows:

• Electronically: Through CoverMyMeds^® or another free ePA tool, such as Surescripts^® or ExpressPAth^®. See Save time and submit your prior authorization requests electronically for pharmacy benefit drugs for more information.
• By phone: Call 1-800-437-3803.
• By fax: Call the Pharmacy Clinical Help Desk at 1-800-437-3803 to obtain the pertinent medication request form, which you can then complete and submit by fax.
• For Blue Cross commercial members: Fax the medication request form to 1-866-601-4425.
• For BCN commercial members: Fax the medication request form to 1-877-442-3778.
• By mail:
  Pharmacy Services — Mail Code 512
  Blue Cross Blue Shield of Michigan
  600 E. Lafayette Blvd.
  Detroit, MI 48226-2998

List of requirements

To view requirements for Skyrizi, Tegsedi and other drugs covered under the pharmacy benefit, see the Prior authorization and step therapy coverage criteria for Blue Cross and BCN at ereferrals.bcbsm.com.

• Blue Cross Pharmacy Benefit Drugs
• BCN Pharmacy Benefit Drugs

For a list of requirements related to drugs covered under the medical benefit, see the Blue Cross and BCN utilization management medical drug list for Blue Cross PPO (commercial) and BCN HMO (commercial) members document.