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Medical Injectables Program Updates: July 2021

Horizon BCBSNJ collaborates with Magellan Rx ManagementSM (MRxM) to administer our Medical Injectables Program (MIP). As part of our shared commitment to help ensure that the medical injectable drugs our members receive are medically necessary and cost effective, the following changes will be made to our MIP.

Medical Necessity and Appropriateness Review of Additional Classified Drugs

For services to be provided on and after July 12, 2021, MRxM will perform MNAR for the following additional injectable medications as part of the MIP.

Brand Name Generic Name HCPCS Code
Blenrep™ belantamab mafodotin-blmf J9037
Monjuvi® tafasitamab-cxix J9349
Viltepso® viltolarsen J1427

 

Use New HCPCS Codes Effective April 2021

 

Based on Centers for Medicare & Medicaid Services’ guidance and in accordance with the American Medical Association, effective April 1, 2021, please use the HCPCS codes noted below for AscenivTM (IV immune globulin) and Visco-3TM (hyaluronan or derivative).

Brand Name Generic Name HCPCS Code
Asceniv™ IV immune globulin J1554
Visco-3™ hyaluronan or derivative J7321

 

MRxM Claim Review

 

The medical injectable drug codes listed below, when included on claims for services rendered on and after July 12, 2021, will be reviewed by MRxM to ensure the billing details are appropriate per our medical policy guidelines. These codes are not subject to MNAR.

Brand Name Generic Name HCPCS Code
Fensolv® leuprolide acetate (for depot suspension) J1950
Pemfexy™ pemetrexed J9304

 

Reminders:

 

  • As part of our MIP, MRxM 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. MRxM 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.

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.

Published on: April 12, 2021, 12:51 p.m. ET
Last updated on: July 8, 2021, 06:43 a.m. ET