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Additional drugs to have site-of-care requirement for most commercial, URMBT members, starting July 1
Act
by Jul 1, 2026
Effective date
Jul 1, 2026
Identified
Jun 16, 2026
Summary
Starting July 1, 2026, Blue Cross Blue Shield of Michigan is adding site-of-care requirements for 12 specialty drugs that already require prior authorization. These drugs will be auto-approved only for office, ambulatory infusion center, or home infusion settings, with additional documentation required for hospital outpatient administration.
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What to do
by Jul 1, 2026 · 3 steps
01Billing team must update prior authorization workflow to include site-of-care selection for tocilizumab and denosumab biosimilars (codes Q5156, J3590, Q5158, Q5136, Q5159).
02Verify current authorization locations for existing patients before renewal.
03Prepare additional documentation processes for any hospital outpatient administrations of these drugs.
Codes mentioned
Q5156J3590Q5158Q5136Q5159
Original notice
Additional drugs to have site-of-care requirement for most commercial, URMBT members, starting July 1
bcbsm.com · Always check the source before changing claims.
Related changes
See all BCBS Michigan changes →HCPCS replacement codes established, effective July 1, 2026HighEffective Jul 1, 2026 · CodingAdditional drugs to require prior authorization for Medicare Advantage members, starting May 11MediumEffective May 11, 2026 · Prior AuthorizationHCPCS replacement codes established, effective April 1, 2026MediumEffective Apr 1, 2026 · CodingAdditional drugs to have site-of-care requirement for most commercial members, starting June 1MediumEffective Jun 1, 2026 · Prior AuthorizationBrowse every BCBS Michigan change in the policy list