Medical Injectables Program Updates: September 2022

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 (MNAR) of Additional Drugs

For services to be provided on and after September 1, 2022, MRxM will perform MNAR for the following additional injectable medications as part of the MIP.

For the unclassified drugs noted below, please also include the appropriate National Drug Code (NDC) when interacting with MRxM and when submitting your claims.

MRxM Claim Review

The medical injectable drug codes listed below, when included on claims for services rendered on and after September 1, 2022, will be reviewed by MRxM to ensure the billing details are appropriate per our medical policy guidelines. These codes are not subject to MNAR.

• 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.

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

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.