MISSOULA, Mont. – Starting April 15, Blue Cross Blue Shield of Montana will require prior authorization for certain asthma injections in a clinic setting.
The change will affect several FDA-approved drugs, including Fasenra, Tezspire, Nucala, and Xolair. The insurance provider will review the medical necessity of administering these self-injecting drugs in medical settings.
Lawren Geer, director of Infusion Providers Alliance, shared insights on why some patients prefer to receive these injections in a healthcare setting. "So, I think the biggest patients at risk are patients with multiple allergies or that are susceptible to hives or have severe asthma because they're at increased risk of suffering allergic reactions when taking these medicines. So imagine you're at risk for getting an allergic reaction to the drug. You have to self inject your home by yourself. You self inject it," Geer said.
Blue Cross Blue Shield explained that the policy revision aims to promote convenient and effective treatment access. They stated that if it is not medically necessary to administer these drugs in a healthcare setting, they may be processed under a member’s pharmacy benefit for self-administration.
These changes will not apply to Medicare and Medicaid plans. Blue Cross Blue Shield will reach out to customers impacted by the policy change. Members with questions are encouraged to contact the number on their ID card or log on to Blue Access for Members℠.
The policy is set to take effect on April 15.
