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Important Changes to Covered Medications

We previously communicated that this change would be effective July 1, 2015. Please be advised that this change will now be effective on October 1, 2015.

Effective October 1, 2015, coverage is changing for the medications listed in the table below.

If your pharmacy benefits are administered by another pharmacy benefits manager, we encourage you to discuss this change with them and how the medications will be covered.

You should always talk to your doctor about available alternatives for getting your medication. Here are some options:

  • Get the medication from a retail pharmacy within our specialty network. A medication copay, deductible and/or co-insurance would apply, and the doctor will need to request prior authorization.
    • The medication can be shipped to the doctor’s office or outpatient hospital clinic for administration. In these instances, an office visit copay, deductible, and/or co-insurance applies.

  • Obtain medication through a home infusion therapy provider.
    If medically appropriate, you can have medication administered by a home infusion therapy provider. To determine if this is the best option for you, consult with your doctor. Your doctor can refer you to a network home infusion therapy provider who can provide and administer the medication either in your home or another convenient setting depending on your specific health care benefits. Prior authorization is required.

If you currently receive medication from a home infusion therapy provider or dialysis facility, there is no change in your coverage. We will be notifying impacted members by September 1, 2015.

Certain in-state physicians and hospitals will continue to be allowed to administer these medications in the doctor’s office or outpatient hospital clinic. Additional information will be shared as it is available.

Medication Name Medication Class
IVIG Immune Serum
Remicade TNF inhibitor
Botulinumtoxin Neuromuscular Blocker

Questions?
If you have any questions, please contact us at the number on the front of your Blue Cross Blue Shield of Massachusetts ID card.

Blue Cross Blue Shield of Massachusetts

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