For This Insurer, Breathing Now Comes With A Catch

[Passages]

Blue Cross Blue Shield just made it harder for many patients to get vital asthma and allergy medications — all while channeling more profits toward a PBM-affiliated pharmacy.

Health Care Apr 25, 2025

Madison, a 12-year-old from Illinois, visits a medical clinic every other week to get injections of Xolair, a powerful asthma and allergy medication. The drug helps protect her from severe asthma attacks as well as serious allergic reactions to peanuts, tree nuts, and sesame seeds. Medical professionals at the clinic monitor her response to the injections, since the drug can trigger life-threatening anaphylactic shock.

But now, thanks to a policy change by her insurer, Blue Cross Blue Shield, Madison may have to self-administer the expensive injections at home.

Without access to in-clinic injections, “I don’t think I would want to do the shot at all,” Madison said. “I don’t know if I would be comfortable even doing it.”

Blue Cross Blue Shield, one of the country’s largest health insurers, just made it much more difficult for patients like Madison to get potentially lifesaving medications. The move will force many patients to self-inject at home, cutting costs for the insurance giant and, experts say, channeling more profits toward a single specialty pharmacy contracted with the insurer.

https://www.levernews.com/for-this-insurer-breathing-now-comes-with-a-catch/

[RockCreek]

1. one ICU stay from someone who does not self administer

will cancel the savings on many thousands of self administered injections.
Dumb, dumb, dumb.
And cruel.

[ret5hd]

2. but think how much each death will save them!

[RockCreek]

3. May every death come with publicity and lawsuits....

[Silent Type]

4. Xoliar is approved for home injections and lots of patients do just that. And BCBS allows exceptions for patients

who cannot safely administer the med.

Personally, I hate needles , but I'd hate going to the doc's office every week even more. That's not true for all patients, and that's what exceptions are for. Obviously, I'm assuming prior approval is not unreasonably withheld. I doubt that will be a problem for someone needing this med.
__________________

Self-Administration:
The change requires patients to self-administer Xolair at home unless their provider obtains prior authorization from Blue Cross Blue Shield, according to Stateline.

Prior Authorization:
If a patient cannot safely self-administer Xolair, a provider needs to request prior authorization to continue receiving it in a healthcare setting, according to Blue Cross and Blue Shield of New Mexico.

From another article:

"Patients in five states who have severe asthma and are covered by Blue Cross Blue Shield are facing a new obstacle to getting treatment. "On Tuesday, BCBS began mandating that severe asthma patients self-administer their drugs at home, unless their provider gets prior approval from the insurance company.

"The patients affected are those covered in Illinois, Texas, Oklahoma, New Mexico, and Montana, but not those with Medicare or Medicaid, the insurance giant says. Those five states are included in a combined BCBS plan which is owned by Health Care Service Corporation."

https://stateline.org/2025/04/15/blue-cross-blue-shield-now-requires-prior-approval-for-severe-asthma-drugs-in-some-states/


Under Medicare, it's a Part B service when performed in a doc's office. It's a Part D covered med for home injections. Medicare and private insurers pay doctors to train patients for home injections. In fact, it's usually recommended that at least 3 injections are performed in the office before considering home injections.

[Passages]

5. Interesting information, thank you.