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Medical Injectables Program Updates: November 2019


In November of this year, the new injectable medications listed below – included recently by the Centers for Medicare & Medicaid Services as part of their Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – August 2019 Update – will be included as part of our Medical Injectables Program (MIP).

  • Beginning with services to be provided on and after November 1, 2019, Magellan Rx Management will conduct medical necessity and appropriateness reviews (MNARs) for the following additional injectable medications as part of the MIP.1
BRAND NAME GENERIC NAME HCPCS
Asparlas™ calaspargase pegol-mknl J9118
Elzonris™ tagraxofusp-erzs J9269
Evenity™ romosozumab-aqqg J3111
Gamifant® emapalumab-lzsg J9210
Kanjinti™ trastuzumab-anns Q5117
Khapzory™ levoleucoforin sodium J0641
Libtayo® cemiplimab-rwlc J9119
Lumoxiti® moxetumomab pasudotox-tdfk J9313
Onpattro® trastuzumab-dttb J0222
Poteligeo® mogamulizumab-kpkc J9204
Synojoynt™ hyaluronan or derivative J7331
Trazimera™ trastuzumab-qyyp Q5116
Triluron™ sodium hyaluronate J7332
Ultomiris™ ravulizumab-cwz J1303
Zirabev™ bevacizumab-awwb Q5118

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.

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 our Medical Injectables Program by conducting medical necessity and appropriateness reviews (MNARs) 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: September 27, 2019, 15:35 PM ET
Last updated on: September 27, 2019, 16:47 PM ET