Oklahoma Allergy and Asthma Clinic pushing back against insurance changes

Oklahomans with Blue Cross Blue Shield may lose coverage for select asthma treatments with new potential policies.

What's Changing?

Blue Cross and Blue Shield is updating medical policies for some medications that are FDA approved for self-administration.

“If not medically necessary to be administered in a healthcare setting under a member’s medical benefit, the drugs may be processed under a member’s pharmacy benefit for self-administration,” the insurance company said in a statement.

The changes will go into effect April 15, 2025.

What Drugs Will Be Impacted?

Four medications will be impacted by the changes:

1. Fasenra (benralizumab), used to treat adults with eosinophilic asthma.
2. Tezspire (tezepelumab), used in combination with other asthma medications for people with severe symptoms.
3. Nucala (mepolizumab), used to treat eosinophilic asthma and other conditions.
4. Xolair (omalizumab), used to treat allergic asthma, chronic hives, certain food allergies and nasal polyps.

How Oklahoma Allergy and Asthma Clinic Is Responding

Dr. Maya Gharfeh, a doctor at the Oklahoma Allergy and Asthma Clinic, says the office is trying hard to fight against the policy change.

“We’re hopeful this change will not happen the way it’s projected to,” said Dr. Gharfeh. “Our concern right now is that this may change our opportunity to care for patients in the most effective way.”

Dr. Gharfeh said she believes self-administering medication can be dangerous, as patients would not be monitored in person by a medical professional for severe reactions or adhere to schedules like an office visit allows.

What Has Blue Cross Blue Shield Said?

Blue Cross and Blue Shield of Oklahoma responded to a News 9 inquiry with a statement.

“This medical policy update promotes access to the treatment via the most convenient and effective benefit for the member. These changes do not apply to Medicare or Medicaid.”

The insurance company tells members to call the number on their member ID or log on to Blue Access for Members with any questions.