Self-Administered Block Medication Update

Self-Administered Block Medication Update

Beginning Jan. 1, 2022, the following specialty medications will no longer be covered or processed under the medical benefit for BlueCross BlueShield of South Carolina members who are subject to the Self-Administered Drug Block (SAB) component of the Specialty Medical Benefit Management (SMBM) program.  In most cases, these drugs can be self-administered by the provider or the member.Drug

Drug Name

J-Code

Afstyla

J7210

Bynfezia Pen

J3490, J3590, C9399

Chorionic Gonadotropin

J0725

Coagadex

J7175

Corifact

J7180

Dupixent

J3490, J3590, C9399

Esperoct

J7204

Fasenra

J0517

Forteo

J3110

Hemlibra

J7170

Idelvion

J7202

Ilumya

J3245

Intron A

J9214

Kevzara (sarilumab)

J3490, J3590, C9399

Kynamro

J3490, J3590, C9399

Natpara

J3490, J3590, C9399

Novarel

J0725

Nucala

J2182

Obizur

J7188

Octreotide

J2354

Otrexup

J3490, J3590, C9399

Ovidrel

J0725

Pregnyl

J0725

Rasuvo

J3490, J3590, C9399

Rebinyn

J7203

Relistor Injection

J2212

Riastap

J7178

Sandostatin

J2354

Sevenfact

J7212

Siliq

J3490, J3590, C9399

Strensiq

J3490

Takhzyro

J0593

Taltz

J3490, J3590, C9399

Tegsedi

C9399, J3490

Teriparatide

J3110

Tremfya

J1628

Tretten

J7181

Tymlos

J3490, J3590, C9399

Tyvaso/Refill Inhalation Solution/Starter Inhalation Solution

J7686

Ventavis

Q4074

Vonvendi

J7179

Vyleesi

J3490, J3590

Xembify

J1558

Any current or active prior authorizations approved prior to Jan. 1, 2022 will remain in place for the member until its expiration date.  Should the member need to fill their drug after Jan. 1, 2022, they will be required to fill it under their specialty pharmacy benefit, not medical.  Please be sure to contact the member’s specialty pharmacy when it’s time to renew their prescription.

Note: Most members are required to have their SAB medications filled with Optum Specialty Pharmacy, our preferred specialty pharmacy.

If you have any questions, please contact Provider Education using the Provider Education Contact Form located on www.BlueChoiceSC.com.