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Medical Injectables Program Update: Medications to be Added

Effective October 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 October 1, 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.

Brand Name Generic Name HCPCS
ADCETRIS brentuximab vedotin J9042
BELEODAQ belinostat J9032
GAZYVA obinutuzumab J9301
KRYSTEXXA pegloticase J2507
MARQIBO vincristine liposomal J9371
MOZOBIL plerixafor J2562
SUSTOL granisetron extended-release J1627
VISCO-3 hyaluronan or derivative J7321
SYNRIBO omacetaxine J9262
ERWINAZE asparaginase J9019
ONCASPAR2 Pegaspargase2 J9266

Review the full list of injectable medications that 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.

2 Horizon BCBSNJ is currently developing a medical policy for ONCASPAR (Pegaspargase). This drug will be added to the MIP on November 1, 2018, to coincide with the implementation date of this new policy. Unless Horizon BCBSNJ provides notice of the cancellation or postponement of this new policy, ONCASPAR will be included as part of our MIP beginning November 1, 2018.

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

Published on: June 29, 2018, 14:15 PM ET
Last updated on: June 29, 2018, 14:34 PM ET