Patients in five states under Blue Cross Blue Shield (BCBS) coverage now face new requirements for obtaining treatment for severe asthma. As of Tuesday, those with severe asthma must self-administer their medications at home unless prior authorization is obtained from the insurer.
This change affects BCBS patients in Illinois, Texas, Oklahoma, New Mexico, and Montana, excluding those under Medicare or Medicaid. These states come under a combined BCBS plan owned by Health Care Service Corporation.
A statement from the corporation indicated that the adjustment aims at “promoting access to treatment that is convenient and effective,” considering the needs of its members.
The medications involved in this policy are biologics, specifically Fasenra (benralizumab), Tezspire (tezepelumab), Nucala (mepolizumab), and Xolair (omalizumab). According to Dr. Bridgette Jones, a pediatric allergy and immunology physician at Children’s Mercy Hospital in Missouri, these drugs are typically prescribed to the most severe cases.
“These are the patients that have failed at other therapies,” said Jones. “Once you’re getting to a biologic, it means that your asthma is not under control, having frequent flare-ups.”
