18 new medications added to the Site of Care program, effective January 1
December 11, 2018 -
18 Medications Added to Site of Care Program – Effective 1/1/19
Effective Jan. 1, 2019, 18 medications will be added to our Site of Care program. Coverage for these medications at an outpatient hospital setting will be approved only if medical necessity criteria are met at the time of prior authorization. This change will not affect inpatient care.
Why The Change?
The outpatient hospital setting is generally recognized as one of the most costly options for specialty infusions with costs up to three times higher compared to non-hospital settings. Infusion sites locations for these medications were identified as an opportunity to help reduce overall health care costs without compromising quality of care.
What This Means for You and Your Patients
CVS Caremark, CareFirst's pharmacy benefit manager, will contact impacted providers to discuss transitioning infusion care to an approved alternate site, including the member's home, an ambulatory infusion center or a physician's office. Impacted members were notified of this change via letter on November 28.
If you have questions, please contact CVS Caremark at 866-655-7444, Monday - Friday, 8 a.m. to 9 p.m., ET.