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February 2021
Some drugs won’t be payable when administered by a health care provider to Blue Cross and BCN commercial membersFor dates of service on or after April 1, 2021, the medications listed below won’t be payable by Blue Cross Blue Shield of Michigan and Blue Care Network when administered by a physician or other health care professional. This change affects Blue Cross commercial and Blue Care Network commercial members. The reason for the change is that these drugs can safely and conveniently be self-administered by the member in the member’s home. They don’t require administration by a health care professional. The following drugs are currently payable under either the medical benefit or the pharmacy benefit. Starting April 1, they’re payable only under the pharmacy benefit.
There are no other changes that apply to the management of these therapies at this time. For more information To view requirements for drugs covered under the pharmacy benefit, see the Blue Cross and BCN Prior authorization and step therapy coverage criteria document. This document is available from the following pages on the ereferrals.bcbsm.com website: 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. We’ll update the requirements lists with the new information prior to April 1, 2021. |
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