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Additional Medications to be added to Our Medical Injectables Program

Effective March 1, 2018, additional injectable medications will be included as part of our Medical Injectables Program (MIP) administered by Magellan Rx Management.

Beginning with services to be provided on and after March1, 2018, Magellan Rx Management will conduct medical necessity and appropriateness reviews (MNARs) for the following additional injectable medications when these injectable medications are administered in a freestanding or hospital-based dialysis center, an outpatient facility, a patient’s home or a physician’s office.1 These changes are based on the American Medical Association’s recommendations.

Generic Name

Brand Name

HCPCS

ATEZOLIZUMAB

TECENTRIQ

J9022

AVELUMAB

BAVENCIO

J9023

GEMTUZUMAB OZOGAMICIN

MYLOTARG

J9203

NUSINERSEN

SPINRAZA

J2326

OCRELIZUMAB

OCREVUS

J2350

OLARATUMAB

LARTRUVO

J9285

TISAGENLECLEUCEL

KYMRIAH

Q2040

Review the revised list of injectable medications that currently require MNAR as part of the MIP, or learn more about our Medical Injectables Program.

If you have questions, please contact your Network Specialist.

1 Medical necessity and appropriateness review is not required for injectable medications that are administered during an inpatient stay, or in an Emergency Room setting or Observation Room setting.

For medical Injectable services rendered in the patient’s home, call 1-855-243-3321 for participating Horizon Care@Home health care professionals to obtain pre-service determination.

Magellan Rx ManagementSM is a service mark of Magellan Health, Inc

Published on: January 30, 2018, 16:14 p.m. ET
Last updated on: April 18, 2018, 07:05 a.m. ET