We’ve often written about the battle being fought around site-of-care. As we’ve suggested previously, it comes down to one word….. MONEY.
Payers have been turning up the flame under the pot in which the battle is being fought. They are increasingly looking to move in more aggressive ways to redirect patinets away from comparatively very expensive hospital outpatient departments and into alternate site of care.
The article below lays out one new strategy by a large payer, Blue Cross Blue Shield of Michigan, to redirect their members to lower cost sites of care. A new policy that went into effect few weeks ago included a targeted list of drugs “may be covered only when administered at the following sites of care:
- Doctor’s or other health care provider’s office
- The member’s home, administered by a home infusion therapy provider
- Ambulatory infusion center.”
Here are the targeted therapies…
- Bavencio
- Imfinzi
- Imjudo
- Jemperli
- Keytruda
- Libtayo
- Opdivo
- Opdualag
- Tecentriq
- Yervoy
- Zynyz
We will not be surprised to see other payers follow this strategy….. especially as each newly infused therapy appears break new records for price.
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Additional drugs to have site-of-care requirements for some Blue Cross commercial members, starting March 15
