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Do you prescribe infused or injected medications?
November 15, 2021

This article is for prescribers of infused and injected medications

As we announced in an October 1, 2021 News Alert, we decided to make our Site of Care program for infused and injected medications voluntary rather than a requirement. Below, we describe what this means for medications you may prescribe and what we’re telling our members.

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What’s the voluntary Site of Care program?

The Site of Care program is designed to promote the use of infused and injected medications in the most cost-effective, clinically appropriate setting. Making this program voluntary gives members options on where we’ll cover their medication.

What this means for you

You can continue to follow your current process for these medications for our commercial (HMO, POS, and PPO) and indemnity members. This includes:

  • Requesting authorization for the medications listed below with an asterisk, just as you do currently. Please refer to the medication’s medical policy for medical necessity criteria we use to make a coverage determination.
    • Note: If you recently received authorization for a drug listed below (noted with an asterisk) with an end date of December 31, 2021, we’ve extended the authorization for one year from the original approval date.
  • Assessing patients who may wish to receive their medication in an alternate site of service, such as home infusion therapy. We hope you’ll join us in discussing the benefits of home infusion therapy with your patients when it’s a clinically appropriate option for them.

Here’s a list of home infusion therapy providers in Massachusetts that have access to these medications.

For patients taking Enytvio or Ocrevus, you can refer to any in-network home infusion therapy provider. We’re also working closely with New England Life Care, and they are prepared to take new referrals.

Infused or injected medications
Aldurazyme Crysvita Givlaari* Lemtrada* Ruconest* VPRIV*
Aralast* Duopa Glassia* Lumizyme Soliris* Vyepti*
Benlysta Elaprase Haegarda* Naglazyme Tysabri* Vyondys 53*
Berinert* Elelyso* Ilumya* Ocrevus Ultomiris* Xolair*
Cerezyme* Entyvio* Kalbitor* Onpattro* Uplizna* Zemaira*
Cinqair* Exondys 51* Kanuma* Prolastin* Viltepso*  
Cinryze* Fabrazyme Krystexxa Radicava Vimizim  

*This medication requires prior authorization. Refer to Medical Utilization Management (MED UM) & Pharmacy Prior Authorization Policy 033.

What we’re telling your patients

We’re advising patients taking the drugs noted above that they continue to have options on where they receive their medication, and that home infusion therapy is a covered option.

Members who received previous letters from us about our Site of Care policy will receive information encouraging them to speak with their doctors to determine if home infusion therapy is a good option for them.

 Member fact sheet
 Member fact sheet for Entyvio and Ocrevus. Members can use any in-network home infusion therapy provider for Entyvio and/or Ocrevus. We’re also working closely with New England Life Care, and they are prepared to take new referrals.

Why patients may consider home infusion therapy for their site of care

Convenience. Home infusion therapy allows your patients to receive treatment in the comfort of their own home from experienced nurses and pharmacists.

Specialized pharmacists provide compounded medications or nutrition for individual patients according to their personalized care plan developed with the patient, their caregivers, and their physician or medical team. Medications are delivered to your patient’s home where specialized nurses teach them how to manage their nutritional and biologic treatments while solely focused on monitoring their advanced home care. If they have questions, help is available 24/7 from their home infusion therapy provider.

Costs. Home infusion therapy is often less costly than other sites of care, so your patient could save money by switching.

Time. Your patients can save time spent commuting to their treatment. Many patients appreciate being able to receive their infusion at home where they spend time working or relaxing.


If you have any questions, please call Clinical Pharmacy Operations at 1-800-366-7778.