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Blue Cross and Blue Shield of Minnesota: New PA requirement for Nusinersen (Spinraza)

BCBSMN is implementing a prior authorization program for the use of Nusinersen (SpinrazaTM) by their members. Please see the announcements below for details.

At Blue Cross and Blue Shield of Minnesota (BCBSMN), member safety is a top concern.

As stewards of healthcare expenditures for our members, we are charged with ensuring the highest quality, evidence based care for our members. One method for doing so is through the Prior Authorization (PA) process. The primary purpose of the PA process is to ensure that evidence based care is provided to our members, driving quality, safety, and affordability. I am writing to share details about our Nusinersen (SpinrazaTM) medical drug policy for our members who may be treated by your contracted providers.

What is changing?
Effective June 19, 2017, BCBSMN will start performing in-house medical necessity reviews for their Commercial and Medicaid lines of business for following medical drug services:

A medical PA will be required every 6 months for the following drug(s), effective June 19, 2017:

  • Nusinersen (SpinrazaTM)

Please note, this PA program requirement does not impact members who have coverage through Federal Employee Program or Platinum Blue (Medicare Cost Plan), as those lines of business have separate PA requirements.

Beginning June 19, 2017, if the services listed above are not preauthorized by your contracted providers for BCBSMN members they treat, the claims may be denied and our members may be responsible for payment of the charges. In addition, if a pre-service review is submitted and not approved before service is provided, members may be held liable for service charges determined to be not medically necessary.

Out of area providers can access BCBSMN’s medical policy information and request pre-service review for BCBSMN members by accessing your Plan’s provider portal.

Questions
If you have questions, please speak with a BCBSMN provider service representative by calling BlueCard Eligibility at 1-800-676-BLUE (2583). If the BCBSMN member’s ID card does not include an alpha prefix, please call the provider service phone number on the ID card.

Spinraza is a trademark of Biogen.

Published on: May 16, 2017, 07:37 a.m. ET
Last updated on: May 18, 2017, 02:57 a.m. ET