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Medical Injectables Program Updates: August 2019

Please review the Medical Injectables Program (MIP) updates noted below.

MEDICATIONS TO BE ADDED

Effective August 1, 2019, additional injectable medications will be included as part of our MIP.

Beginning with services to be provided on and after August 1, 2019, Magellan Rx Management will conduct medical necessity and appropriateness reviews (MNARs) for the additional injectable medications listed below which were included as part of the Center for Medicare & Medicaid Services’ Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2019 Update.

Brand Name Generic Name HCPCS
Belrapzo bendamustine hydrochloride J9036
Herceptin Hylecta trastuzumab-hyaluronidase-oysk J9356
Herzuma trastuzumab-pkrb Q5113
Ogiviri trastuzumab-dkst Q5114
Ontruzant trastuzumab-dttb Q5112
Truxima rituximab-abbs Q5115

Coding for Rebinyn®

Earlier this year we announced that effective August 15, 2019, Magellan Rx ManagementSM (MRxM) will conduct medical necessity and appropriateness review (MNAR) for certain hemophilia drugs as part of our MIP.¹

Based on Centers for Medicare & Medicaid Services’ guidance, please use the HCPCS code noted below when submitting claims for Rebinyn (coagulation factor IX [recombinant], GlycoPEGylated).

Brand Name Generic Name HCPCS
Rebinyn® coagulation factor IX (recombinant), GlycoPEGylated J7203

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 As 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.

REBINYN® is a registered trademark of Novo Nordisk A/S.

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.

Published on: July 1, 2019, 05:03 AM ET
Last updated on: July 1, 2019, 08:13 AM ET