We’re adding site-of-care requirements for Lemtrada and Tysabri for commercial members, starting May 1

Starting May 1, 2020, the medical drug site-of-care program is expanding to include the following drugs for Blue Cross Blue Shield of Michigan and Blue Care Network commercial members:  

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

Through April 30, 2020, members who receive 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 won’t be covered at hospital outpatient facilities.** Before May 1, talk to your patients about making arrangements to receive infusion services at one of the following locations:

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

**Based on Risk Evaluation and Mitigation Strategies, or REMS, program restrictions, administration of Lemtrada and Tysabri is limited to authorized locations. We’ll post information about in-state and nationally authorized administration sites to our ereferrals.bcbsm.com website soon to aid in member transition. We’ll provide an update when this information is available.

More about the authorization requirements
The authorization requirements apply only to groups that are currently participating in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. These changes don’t apply to 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, see the Blue Cross and BCN utilization management medical drug list document located on our ereferrals.bcbsm.com website:

• The Blue Cross Drugs Covered Under the Medical Benefit webpage
• The BCN Drugs Covered Under the Medical Benefit webpage

We’ll update the requirements list for the drugs listed above before May 1, 2020.