Medical Injectables Program Update: Retacrit

Effective November 1, 2018, additional injectable medications, recently approved by the FDA, 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 November 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

Brand Name Generic Name HCPCS
RETACRIT (ESRD Only) EPOETIN ALFA-EPBX, BIOSIMILAR
(ESRD Only)
Q5106
RETACRIT (Non-ESRD) EPOETIN ALFA-EPBX, BIOSIMILAR
(Non-ESRD)
Q5105

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

As previously announced, and as noted in our list of injectable medications that require MNAR as part of the MIP, ONCASPAR (Pegaspargase) will also be added to the MIP on November 1, 2018.

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 Management℠ is a service mark of Magellan Health, Inc.

Published on: September 26, 2018, 10:33 AM ET
Last updated on: September 26, 2018, 10:34 AM ET