We’re changing how we manage biologic asthma therapies, starting Jan. 1

Starting Jan. 1, 2023, Blue Cross Blue Shield of Michigan and Blue Care Network are changing how we manage some biologic asthma medications for all Blue Cross and BCN group and individual commercial members.

The following biologic asthma therapies will be affected by this change:

• Fasenra^® (benralizumab), HCPCS code J0517
• Nucala^® (mepolizumab), HCPCS code J2182

Fasenra and Nucala will continue to be covered under the medical benefit when administered by a health care professional. They’ll be managed under the pharmacy benefit when self-administered.

Starting Jan. 1, these drugs will no longer be covered under the medical benefit when they’re self-administered by a member.

Note: We’ve updated the medical policies for these drugs to reflect this change. You can view the medical policies through the Medical Policy Router Search page of bcbsm.com.

How to submit prior authorization requests

When Fasenra or Nucala will be self-administered, submit the request using an electronic prior authorization, or ePA, tool such as CoverMyMeds^® or Surescripts^®.

When Fasenra or Nucala needs to be administered by a health care professional, submit the request through the NovoLogix^® online tool.

What you need to do for members who self-administer these drugs

For members who self-administer these drugs and don’t have pharmacy benefits through Blue Cross or BCN, providers need to work with the member’s pharmacy vendor to ensure that the drug is covered.

For members who self-administer these drugs and do have pharmacy benefits through Blue Cross or BCN, providers will need to submit a prior authorization request under the member’s pharmacy benefit.

Members can obtain these drugs through an AllianceRx Walgreens Pharmacy.

Why we’re making this change

We’re making this change as part of our continued effort to provide members with access to the best health care at the lowest cost. The management changes for this drug class ensure that we’re taking the most cost-effective approach by reducing the cost to our members and to the plan. In addition, these changes ensure that patient health and outcomes aren’t affected while delivering value to members.

List of requirements

For a full 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 commercial and BCN commercial members.

For a full list of requirements related to drugs covered under the pharmacy benefit, see the Prior authorization and step therapy coverage criteria.

We'll update these lists to reflect the changes related to these drugs prior to the effective dates.

Authorization isn't a guarantee of payment. As always, health care practitioners need to verify eligibility and benefits for members.