Five Blue Cross Blue Shield plans will require prior approval for certain severe asthma medications when administered in a healthcare setting, as part of a broader update to its medical policies for self-administered drugs.
The change includes four injectibles commonly used to treat severe asthma, including Fasenra, Tezspire, Nucala and Xolair, according to an April 15 news release.
The policy applies to members in Illinois, Oklahoma, New Mexico, Montana and Texas, all part of Health Care Service Corp., and excludes those who are covered by Medicare, Medicaid and Illinois HMO plans.
Blue Cross Blue Shield said it will now assess the medical necessity of clinic based administration for the medications and if deemed necessary, patients must shift to self injection. The treatments will also be processed as a pharmacy benefit instead of a medical benefit.
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