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Additional drugs to have site-of-care requirement for most commercial members, starting June 1
Act
by Jun 1, 2026
Effective date
Jun 1, 2026
Identified
Jun 16, 2026
Summary
Starting June 1, 2026, Blue Cross Blue Shield of Michigan and Blue Care Network are adding site-of-care requirements for 12 specialty drugs already requiring prior authorization. Providers must now specify and justify the administration site when requesting prior authorization, with automatic approval for office, ambulatory infusion center, or home settings, but additional documentation required for hospital outpatient settings.
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What to do
by Jun 1, 2026 · 3 steps
01Clinical and billing teams must update prior authorization workflows to include site-of-care selection when requesting approval for the listed specialty drugs (eculizumab, ustekinumab variants, and cipaglucosidase alfa).
02Ensure staff are trained to select appropriate administration sites (office, ambulatory center, or home) for automatic approval, or prepare additional documentation if hospital outpatient setting is required.
03Update internal processes to verify group participation in Medical Drug Prior Authorization Program using the Specialty Pharmacy Master Opt-in/out Group list.
Codes mentioned
Q5151Q9999J1203Q9997Q9998Q5099Q5138
Original notice
Additional drugs to have site-of-care requirement for most commercial members, starting June 1
bcbsm.com · Always check the source before changing claims.