Medical Injectables Program Updates: April 2023

Please review the upcoming changes to our Medical Injectables Program (MIP) administered by Magellan Rx Management (MRxM).

• Medical Necessity and Appropriateness Review (MNAR)
  Beginning for services to be provided on and after April 24, 2023, MRxM will conduct MNAR for the following injectable medications as part of the MIP.

  BRAND NAME	GENERIC NAME	HCPCS CODE	NDC
  Elahere™	mirvetuximab soravtansine-gynx	J9999	72903-853-01
  Tecvayli™	teclistamab-cqyv	J9999	57894-449-01 57894-450-01
  Imjudo™	tremelimumab-actl	J9999	0310-4505-25 0310-4535-30

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

Magellan Rx Management℠ 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 web page 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 Blue Shield Association.