Soliris Added to Site of Care Management
April 20, 2018 -
Effective May 2, 2018, coverage for Soliris 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.
What This Means for You and Your Patients
Patients receiving care under an existing prior authorization will not be subject to site of care management until prior authorization expiration.
CVS Caremark, CareFirst’s pharmacy benefit manager, will contact impacted providers and patients to discuss transitioning infusion care to an approved non-hospital based setting, including the patient’s home, an ambulatory infusion center or a physician’s office. Impacted providers and patients will also be notified via letter of this change.
Do you have questions?
Please contact CVS Caremark at 866-655-7444, Monday - Friday, 8 a.m. to 8 p.m., ET.