Specialty Drug Updates

Applying medical policy criteria completely and accurately is critical to ensure benefits and reimbursement are applied correctly to our members’ claims. System updates are also necessary to ensure proper payments and medical policy alignment are applied.

The processing system of BlueCross® BlueShield® of South Carolina and BlueChoice HealthPlan will be updated to better align the effectuation of our current medical policies around certain medical specialty drugs. As a valued network provider, we wanted to share this important information with you and thank you for servicing our members.

On April 25, 2022, the following drugs will be impacted by this update:

  • Actemra® (Tocilizumab)                           CAM 061
  • Avastin® (Bevacizumab)                           CAM 067, CAM 5107 and CAM 50118
  • Remicade® (Infliximab)                            CAM 50115

On May 30, 2022, the following drugs will be impacted by this update:

  • Tecentriq™ (Atezolizumab)                       CAM 150
  • Darzalex® (Daratumumab)                      CAM 172
  • Darzalex® FasPRO (Daratumumab)        CAM 172
  • Imfinzi® (Durvalumab)                              CAM 216
  • Opdivo® (Nivolumab)                               CAM 106
  • Soliris® (Eculizumab)                                CAM 220
  • Ultomiris™ (Ravulizumab)                        CAM 220
  • Yervoy® (Ipilimumab)                               CAM 091
  • Entyvio™ (Vedolizumab)                          CAM 104

On June 27, 2022, the following drugs will be impacted by this update:

  • Lucentis® (Ranibizumab)                        CAM 30927
  • Eylea® (Aflibercept)                                CAM 90327
  • Xolair® (Omalizumab)                            CAM 058
  • Immune Globulin Therapy                     CAM 80105
  • Krystexxa® (Pegloticase)                        CAM 084
  • Nucala® (Mepolizumab)                         CAM 141
  • Ocrevus® (Ocrelizumab)                         CAM 170
  • Stelara® (Ustekinumab)                          CAM 194
  • Neulasta® (Pegfilgrastim)                       CAM 197
  • Tysabri® (Natalizumab)                          CAM 059

Note: The medical policies have not changed. The diagnoses listed on each policy are not a guarantee of payment and are listed for your reference. They may not be all-inclusive.

We recommend frequently visiting the Medical Policies to remain abreast of any policy updates.

Once you have accessed the Medical Policies pages:

  1. Key the policy number in the search box (e.g., CAM 061); select Search
  2. Select Show Advanced Options
  3. Select Exact Phrase; select Search
  4. Select the corresponding policy

If you have any questions, please feel free to contact the provider education team at 803-264-4730 or reach out to your education representative directly.

 

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross BlueShield Association.