September 2021

We’re changing how we pay for certain drugs that should be administered by health care provider

Starting Oct. 1, 2021, Blue Cross Blue Shield of Michigan and Blue Care Network will no longer pay for the following drugs under a patient’s drug benefits. These medications should only be administered by a health care provider, and we’ll only pay for them under a patient’s medical benefits.

Our drug plans only pay for drugs that can be self-administered by the patient, as per prescription labeling approved by the Food and Drug Administration.

If members fill a prescription for one of these drugs at a pharmacy on or after Oct. 1, 2021, they’ll be responsible for the full cost.

Drugs that will be paid for by medical benefits starting Oct. 1, 2021	HCPCS code	Common use
Eligard^®	J9217	Prostate cancer
Lupron Depot^® 7.5mg, 22.5mg, 30mg and 45mg	J9217	Prostate cancer
Trelstar^®	J3315	Prostate cancer
Zoladex^®	J9202	Prostate cancer, endometriosis, endometrial thinning, breast cancer

We’ll notify affected members of these changes and advise them to talk with their provider about continuing to receive their treatment.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2020 American Medical Association. All rights reserved.