For Blue Cross' PPO (commercial) and BCN HMO^SM (commercial) members, ketoprofen 25 mg will require authorization and have new quantity limits

The following changes are coming for Blue Cross' PPO (commercial) and BCN HMO (commercial) members:

• For new courses of treatment involving ketoprofen 25 mg that begin on or after Dec. 1, 2019, you'll have to obtain authorization. If you don't obtain authorization, the member may be responsible for the full cost of the drug.
• Effective March 1, 2020, ketoprofen 25 mg will be limited to four capsules per day or 120 capsules per 30 days. Requests for Blue Cross Blue Shield of Michigan and Blue Care Network to cover greater quantities will need to include documentation showing that the greater quantity is medically necessary.

Members who start taking ketoprofen prior to Dec. 1, 2019, can continue their treatment courses. However, as of March 1, 2020, you'll need to obtain authorization for these members to continue therapy.

For treatment courses starting on or after Dec. 1, 2019, you'll need to obtain authorization before members begin taking ketoprofen.

We'll notify affected members of these changes, and we'll encourage them to talk to you if they have concerns.

Authorization isn't a guarantee of payment. Health care providers need to verify eligibility and benefits for members.

Note: These requirements don't apply to Medicare Plus Blue^SM PPO or BCN Advantage^SM members.

Posted: October 2019
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network