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|
|Berinert®||c1 inhibitor (human)||J0597|
|Cinryze®||c1 inhibitor (human)||J0598|
|Ruconest®||c1 esterase inhibitor [recombinant]||J0596|
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.