Stateline: Blue Cross Blue Shield now requires prior approval for severe asthma drugs in some states

By Nada Hassanein

Patients in five states who have severe asthma and are covered by Blue Cross Blue Shield are facing a new obstacle to getting treatment.

On Tuesday, BCBS began mandating that severe asthma patients self-administer their drugs at home, unless their provider gets prior approval from the insurance company.

The patients affected are those covered in Illinois, Texas, Oklahoma, New Mexico, and Montana, but not those with Medicare or Medicaid, the insurance giant says. Those five states are included in a combined BCBS plan which is owned by Health Care Service Corporation.

In a statement, the corporation said the change is “being made with the interests of our members in mind — promoting access to treatment that is convenient and effective.”

Given as injections, the treatments in question are Fasenra (benralizumab), Tezspire (tezepelumab), Nucala (mepolizumab) and Xolair (omalizumab). All belong to a class of drugs known as biologics.

The sickest asthma patients are often on biologics, explained Dr. Bridgette Jones, past chair of the American Academy of Pediatrics’ drug committee and the American Academy of Allergy Asthma and Immunology’s asthma cough diagnosis and treatment panel.

“These are the patients that have failed at other therapies,” said Jones, a pediatric allergy and immunology physician at Children’s Mercy Hospital in Missouri. “Once you’re getting to a biologic, it means that your asthma is not under control, having frequent flare-ups.”

Read the full article via Stateline

Children's Mercy Division of Allergy, Immunology, Pulmonary and Sleep Medicine