Blue Cross NC is working to help members with complex medical conditions get the care they need in the most cost-effective way. Costs for drug infusions are much higher at a hospital’s outpatient facility than at other settings.
For this reason, we’re expanding our list of provider-administered medications that can be given at other locations. The Place of Service for Medical Infusions Policy already applies alternate location guidelines for medications ordered in these therapy categories:
- Alpha-1 proteinase inhibitors
- Hereditary angioedema
- Multiple sclerosis
- Autoimmune and respiratory disorders
Additional infusion medications, newly approved by the FDA, that are appropriate for site of care requirements may be added to this expanded policy.
Medically Unstable Patients
Blue Cross NC members’ benefits and coverage availability for some other provider-administered medications may be limited to infusion services at non-hospital locations, unless the member is considered medically unstable, or an infusion is not clinically appropriate outside a hospital setting.
Medically Stable Patients
Blue Cross NC members considered medically stable may be required to receive some provider-administered medications at approved locations, including:
- Non-hospital outpatient centers
- Physicians’ offices
- Ambulatory and home infusion
New or Renewal Authorization Requests
A site outside of a hospital outpatient setting must be located at the time the new or renewal request is made. Please work with your Blue Cross NC patients if changes to their care locations are necessary.
Important Note: Requests for provider-administered medications and infusion services under this policy and provided at hospital outpatient locations are not eligible for reimbursement under Blue Cross NC members’ benefits, unless approved in advance by Blue Cross NC. Blue Cross NC members with existing authorizations and currently getting infusion services at hospital outpatient locations may continue to get these infusions until their authorization period ends.
Visit our Prior Review and Limitations page for detailed site of care requirements, to see our revised medical policy for Place of Service for Medical Infusions notification, or you can find the requirements listed in each individual medical policy for an applicable infusion medication.