Updated: We’ve added site-of-care requirements for Lemtrada and Tysabri for commercial members

We’re updating an article published in the March 2020 issue of The Record. We’re providing a link to an FAQ — Lemtrada^® and Tysabri^® site-of-care program: Frequently asked questions for providers — that contains additional program information and details on authorized administration sites in Michigan and elsewhere in the U.S. Please refer to this article for the most up-to-date information.

As of May 1, 2020, the medical drug site-of-care program expanded for Blue Cross’ PPO (commercial) and BCN HMO^SM (commercial) members to include:

• Lemtrada (alemtuzumab, HCPCS code J0202)
• Tysabri (natalizumab, HCPCS code J2323)

Through April 30, 2020, members who received these drugs in one of the following locations are authorized to continue treatment:

• Doctor’s office or other health care provider’s office
• Ambulatory infusion center
• Hospital outpatient facility

Starting May 1, 2020, infusions of Tysabri and Lemtrada may not be covered at hospital outpatient facilities.** Members receiving these medications at a hospital outpatient facility should talk to their doctors about arranging to receive infusion services at one of the following locations:

• Doctor’s office or other health care provider’s office
• Ambulatory infusion center

More about the authorization requirements
The authorization requirements apply only to groups currently participating in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. These changes don’t apply to the Federal Employee Program^® Service Benefit Plan members.

Authorization isn’t a guarantee of payment. Health care practitioners need to verify eligibility and benefits for members.

List of requirements
For a list of requirements related to drugs covered under the medical benefit, please see the Blue Cross and BCN utilization management medical drug list document located on our ereferrals.bcbsm.com website:

• The Blue Cross Medical Benefit Drugs - Pharmacy webpage
• The BCN Medical Benefit Drugs - Pharmacy webpage

We’ve updated the requirements list with the new information about Lemtrada and Tysabri.

**Based on Risk Evaluation and Mitigation Strategies program restrictions, administration of Lemtrada and Tysabri is limited to authorized locations. For Lemtrada, we’ll restrict transitions to select locations that have safety protocols in place for adverse reactions. To aid member transition, refer to Lemtrada and Tysabri site-of-care program: Frequently asked questions for providers, a document that contains additional program information and details on authorized administration sites in Michigan and elsewhere in the U.S.