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.
= new reply since forum marked as read