CommercialPrior AuthMedium impact
Additional drugs to have site-of-care requirement for most commercial, URMBT members, starting July 1
BCBS Michigan·MI · Rheumatology, Oncology, Endocrinology +1 more·Prior Authorization
Effective date
Jul 1, 2026
We identified it
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.
Action Required
By July 1, 2026: Billing team must update prior authorization workflow to include site-of-care selection for tocilizumab and denosumab biosimilars (codes Q5156, J3590, Q5158, Q5136, Q5159). Verify current authorization locations for existing patients before renewal. Prepare additional documentation processes for any hospital outpatient administrations of these drugs.