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GlobalHealth Site of Care program focuses on infused specialty medications within several therapeutic classes including immune deficiencies, inflammatory bowel, Rheumatoid arthritis, multiple sclerosis, etc. The program identifies members who are receiving select infused specialty medications at a hospital outpatient setting and helps direct them to the most clinically appropriate alternative site of care. Alternative sites of care include infusion centers, physician offices and home infusion.

The first dose of medication may be given in a hospital outpatient setting when requirements for first dose administration cannot be met by preferred place of service. A hospital outpatient setting may also be used if member specific factors exist preventing administration at a preferred setting.

A non-preferred setting may be used after first dose administration if your physician provides Medical Necessity documentation. If medical necessity documentation is not provided, infusions will be directed to a preferred site of care, such as a home infusion or infusion suite/center.

All medications within the program require clinical authorization before medication can be dosed. Speak to your healthcare provider prior to receiving treatment to ensure this has been met.

Click here to view a list of Site of Care medications. This is not an all-inclusive list, medications may be added or removed at any time as determined clinically appropriate.

Term

Description

Preferred Site of Care

Location where medications are safely and effectively administered by a health care professional.

Approved sites of care include:

  • BriovaRx infusion Services
  • OptionOne infusion centers
  • Coram
  • OptionCare
  • Home infusion

Non-Preferred Site of Care

Hospital location where medications are administered by a professional and the facility is reimbursed for the medication and services at a much higher rate than preferred sites of care.

Criteria required sites of care include:

  • Outpatient Hospital-based infusion centers