New Policy Established for Certain Infused Drugs

Highmark’s ongoing commitment is to deliver safety, value, and convenience while reducing the high cost of medications for our members.

For those reasons, we’ve established a new medical policy, I-151, regarding certain infused medications. Taking effect Jan. 1, 2019, infusion medication may be considered medically necessary when certain clinical criteria for individual medication policies are met and when the infused drugs are administered in:

• A physician’s office not affiliated with a hospital.
• A specialized infusion center not affiliated with a hospital.
• The patient’s home.

Additional medical necessity criteria have been established for infusions that are administered in an outpatient facility or hospital. Members will still be able to receive their infusion in a hospital-based setting if medically necessary, based on the policy criteria. 

For more information on this important policy, see the Special Bulletin dated Nov. 1, 2018.