Mandatory Site of Service Policy

The Mandatory Site of Service policy is part of the Provider-Administered Drug Review Program. The primary objective of Mandatory Site of Service is to guide the administration of select drug infusions to the most economic and clinically appropriate place of treatment:
 

• Patients receiving ongoing medical specialty drug infusions in an outpatient facility are required to transition the administration of their infusions to a home setting.

• The patient must have home infusion benefits that allows for coverage of drug infusions.
   
• The patient and the provider must agree to transition care to the alternate setting.
   
• The physician must provide necessary prescriptions and authorizations needed to transition the member's infusion to an alternate place of treatment OR supply satisfactory information supporting an exclusion as stated in the policy.
   
• All drugs included require precertification through Prime Therapeutics.
   
• When required, the home infusion provider will obtain all necessary nursing precertifications as specified by the patient's benefits.

Note: Coverage is subject to the member's specific benefits. Group-specific benefits will supersede these policies when applicable. Always check eligibility and benefits through your local Blue Plan provider portal or your practice management system to confirm member-specific benefits. 

Review the policy below for full details.