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Medical Injectables Program Updates: November 2020

As part of our Medical Injectables Program (MIP), Magellan Rx Management will require additional medical record information to conduct medical necessity and appropriateness reviews (MNARs) of the medical injectable drugs listed below that are to be provided on and after November 1, 2020.

  • Beginning with services to be provided on and after November 1, 2020, Magellan Rx Management will require medical record information as part of the MNAR process¹ to help ensure that the prescribed medical injectable drug is appropriate to treat the patient’s illness/condition.
Brand Name Generic Name HCPCS
Aldurazyme® laronidase J1931
Berinert® c1 inhibitor (human) J0597
Blincyto® blinatumomab J9039
Brineura® cerliponase alfa J0567
Cerezyme® imiglucerase J1786
Cinryze® c1 inhibitor (human) J0598
Elaprase® idursulfase J1743
Elelyso® taliglucerase alfa J3060
Kalbitor® ecallantide J1290
Kanuma® sebelipase alfa J2840
Krystexxa® pegloticase J2507
Lumizyme® alglucosidase alfa J0221
Mepsevii™ vestronidase alfa-vjbk J3397
Naglazyme® galsulfase J1458
Onpattro® patisiran J0222
Poteligeo® mogamulizumab-kpkc J9204
Proleukin® aldesleukin J9015
Ruconest® c1 esterase inhibitor [recombinant] J0596
Soliris® eculizumab J1300
Spinraza® nusinersen J2326
Ultomiris™ ravulizumab-cwz J1303
Vimizim® elosulfase alfa J1322
Vpriv® velaglucerase alfa J3385

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.

¹As 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 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: July 27, 2020, 21:39 p.m. ET
Last updated on: July 28, 2020, 05:42 a.m. ET