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Medical Injectables Program Updates: April 2020

Effective April 24, 2020, Magellan Rx Management (MRxM) will no longer conduct medical necessity and appropriateness reviews (MNARs) for the injectable medications listed below as part of our Medical Injectables Program (MIP).¹

BRAND NAME GENERIC NAME HCPCS
Alimta® pemetrexed J9305
Beovu® brolucizumab-dbll J0179
Botox® onabotulinumtoxina J0585
Dysport® abobotulinumtoxina J0586
Eylea® aflibercept J0178
Halaven® eribulin J9179
Lucentis® ranibizumab J2778
Macugen® pegaptanib sodium J2503
Myobloc® rimabotulinumtoxinb J0587
Xeomin® incobotulinumtoxina J0588

MRxM CLAIM REVIEW
Though not subject to MNAR as part of the MIP, the medical injectable drug codes listed above included on claims for services rendered on and after April 24, 2020, will be reviewed by MRxM to ensure the billing details are appropriate per our medical policy guidelines.²

These medical injectable drugs are added to the previously announced drugs for which MRxM drugs currently performs claim review.

If you have any questions, please contact your Network Specialist, Network Hospital Specialist or Ancillary Contracting Specialist.

¹As part of our MIP, Magellan Rx Management conducts MNARs for injectable medications administered in a freestanding or hospital-based dialysis center, an outpatient facility, a patient’s home or a physician’s office. Magellan Rx Management does not conduct MNARs for injectable medications administered during an inpatient stay, or in an Emergency Room 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 We encourage you to review the medical policy criteria and guidelines for the injectable medications included as part of the MIP within our Medical Policy Manual.

Magellan Rx ManagementSM is a service mark of Magellan Health, Inc. Magellan Rx Management is an independent company that supports Horizon Blue Cross Blue Shield of New Jersey in the administration of conduct medical necessity and appropriateness review (MNAR) for certain medical injectable drugs. Magellan Rx Management is independent from and not associated with Horizon Blue Cross Blue Shield of New Jersey.

This document contains prescription brand name drugs that are registered marks or trademarks of pharmaceutical manufacturers that are not affiliated with Magellan Rx Management, Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross and Blue Shield Association.

Published on: April 9, 2020, 06:02 a.m. ET
Last updated on: April 9, 2020, 15:22 p.m. ET