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Arkansas BlueCross BlueShield: Six specialty medications to need prior approval beginning April 2018

Due to dramatic costs and complexity associated with the administration of certain specialty medications, effective April 1, 2018, prior approval will be required by Arkansas Blue Cross and Blue Shield for payment of the following specialty medications used in treating rare, complex conditions:

  • Nusinersen (Spinraza) – Spinal muscular atrophy
  • Cerliponase alfa (Brineura) – Late infantile neuronal ceroid lipofuscinosis type 2 (CLN2 or Batten disease)
  • Eculizumab (Soliris) – Paroxysmal nocturnal hemoglobinuria (PNH), atypical (complement mediated) hemolytic uremic syndrome (aHUS), and refractory generalized AchR positive myasthenia gravis
  • Alemtuzumab (Lemtrada) – refractory relapsing remitting multiple sclerosis
  • Asfotase alfa (Strensiq) – Perinatal/infantile or juvenile-onset hypophosphatasia
  • Metreleptin (Myalept) – Congenital or acquired complete generalized lipodystrophy (GL) with leptin deficiency

Specialty medications already needing prior approval include:

  • Omalizumab (Xolair) – Moderate to severe persistent asthma and chronic idiopathic urticaria
  • Mepolizumab (Nucala) – Severe persistent asthma with an eosinophilic phenotype in patients 12 years of age or older

By establishing a prior approval process, members and providers will know whether the member qualifies for these drugs. A concurrent review will be conducted six months after approval to determine whether a patient is benefitting from the prescribed medication.

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