Publication Date: 

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is expanding our existing policy, Place of Service for Medical Infusions. The policy applies to where provider-administered medication can be given.

Why Blue Cross NC is expanding the policy

  • Costs for drug infusions are significantly higher at a hospital’s outpatient facility than other settings.
  • We are working to help our members with complex medical conditions to get the care they need in the most cost-effective way.

What you should know

  • The policy includes medications ordered within select therapeutic categories, including alpha-1 proteinase inhibitors, hereditary angioedema, multiple sclerosis, autoimmune and respiratory disorders.
  • Beginning April 1, 2018, all new requests for the select medications will require a medical necessity and a place of service review.
  • We’ve created a helpful frequently asked questions document with a full list of applicable medication.
  • Benefits and the availability of coverage for provider-administered medications will be limited to infusion services provided at non-hospital locations, unless the member is considered medically unstable or meets the medical policy coverage criteria for continued administration in an outpatient setting.
  • New requests for select medications will require a place of service review.

Information for State Health Plan (SHP) Members

  • Beginning April 1, 2018, all North Carolina State Health Plan for Teachers and State Employee members considered medically stable will be required to receive the select medications at approved locations.
    • This includes non-hospital outpatient centers, physicians’ offices, ambulatory centers and home infusion.
  • The week of March 2, 2018, we will mail letters about this to:
    • Providers that treated a SHP member within the last six months with an applicable medication
    • SHP members that received an applicable medication within the last six months
  • SHP members with existing authorizations and currently receiving infusion services at outpatient hospital locations will have a 30-day grace period to transition to a new site of care, ending April 30, 2018. 
  • We want to help you, and our members, through this transition. If you have patients that need to change the location where they receive infusion services, we will contact you. Over the next 30 days, a representative from Blue Cross NC will be reaching out to assist in this transition.
  • Blue Cross NC will expand implementation of this policy to additional commercially-insured members later this year. We will provide advance notice. 

For further assistance please call our Provider Blue LineSM at 1-800-214-4844.