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Medical Injectables Program Updates: October 2021

Horizon BCBSNJ collaborates with Magellan Rx Management℠ (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 October 15, 2021, MRxM will perform MNAR for the following additional injectable medications as part of the MIP.

Brand Name

Generic Name

HCPCS Code

Oxlumo™

lumasiran

J0224

Danyelza®

naxitamab-gqgk

J9348

Margenza™

margetuximab-cmkb

J9353

Riabni™

rituximab-arrx

Q5123

If you have any questions, please contact your Network Specialist or Ancillary Contracting Specialist.

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: July 16, 2021, 12:59 p.m. ET
Last updated on: July 13, 2021, 06:17 a.m. ET