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Medical Injectables Program Updates: January 2023

Horizon collaborates with Magellan Rx Management (MRxM) to administer its Medical Injectables Program (MIP). As part of our shared commitment to help ensure that the medications our members need are medically necessary and cost effective, the following changes will be made to our MIP.

  • Medical Necessity and Appropriateness Review

    Beginning with services provided on and after January 23, 2023, MRxM will conduct medical necessity and appropriateness reviews (MNAR) for the following injectable medications as part of the MIP.

    Opdualag™ nivolumab/relatlimab-rmbw J9298
    Amvuttra™ vutrisiran J3490 71336-1003-01
    Fylnetra® pegfilgratim-pbbk J3590 70121-1627-01
    Lanreotide Acetate lanreotide J1932
    Alymsys® bevacizumab-maly J9999

If you have any 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.

Published on: October 24, 2022, 02:37 a.m. ET
Last updated on: October 18, 2022, 02:58 a.m. ET