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Medical Injectables Program Process Update: New-to-Market Drugs

Horizon collaborates with Magellan Rx Management (Magellan Rx), a specialty pharmaceutical management company to manage our Medical Injectables Program (MIP). Beginning in 2023, we will follow the process outlined below in regard to the inclusion of new-to-market (NTM) drugs to our Medical Injectables Program (MIP).

Initial Notification

Horizon will post an online news item within our News & Legal Notices to provide at least 30 days' advance notice before a NTM drug is added to our MIP.

At the time of this news posting, the NTM drug, its corresponding not-otherwise-classified (NOC) HCPCS code and its NDC number) will be added to our list of Injectable Medications subject to Medical Necessity and Appropriateness Review (MNAR).

Medical Policy Guidelines

Until medical policy guidelines are developed, published and announced online within our Medical Policy Manual, our approach to NTM drugs will be based solely on prescribing information (packet insert).

HCPCS Assignment

When the Centers for Medicare & Medicaid Services (CMS) assigns a specific code to a NTM drug included in our MIP, we will update the online list of Injectable Medications subject to MNAR to replace the NOC code/NDC number with the assigned specific HCPCS code.

We will not post a news item to advise when CMS assigns a specific HCPCS code to drug. Our expectation is that providers will access the publicly available HCPCS Quarterly Update information on CMS.gov to understand when HCPCS codes are assigned.

Published on: November 21, 2022, 04:53 a.m. ET
Last updated on: November 15, 2022, 06:57 a.m. ET