Avsola™ and Givlaari™ will have authorization and site of care requirements for commercial members effective February and March 2020

We're adding authorization and site of care requirements for specialty drugs covered under the medical benefit for the following drugs for Blue Cross' PPO (commercial) and BCN HMOSM (commercial) members:

  • Avsola (infliximab-axxq, HCPCS code J3590)
  • Givlaari (givosiran, HCPCS code J3490)

For BCN HMO members

  • We'll require authorization for Avsola and Givlaari for members who begin therapy on or after Feb. 6, 2020.
  • Avsola and Givlaari will be added to the site of care program for BCN HMO members, effective Feb. 6, 2020.

For Blue Cross' PPO members

We'll require authorization for Avsola and Givlaari for members who begin therapy on or after March 1, 2020.

More about these requirements

These requirements apply only to groups that are currently participating in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. These changes don't apply to members covered by the Federal Employee Program® Service Benefit Plan.

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

List of requirements

For a list of requirements related to drugs covered under the medical benefit, please see the Requirements for drugs covered under the medical benefit - BCN HMO and Blue Cross PPO document located on this website:

We'll update the requirements list for these drugs prior to the effective dates for the changes.

Posted: January 2020
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network