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Medications to be added to our Medical Injectables Program: February 2019

Effective February 1, 2019, additional injectable medications will be included as part of our Medical Injectables Program (MIP) administered by Magellan Rx Management℠.

Beginning with services to be provided on and after February 1, 2019, Magellan Rx Management will conduct medical necessity and appropriateness reviews (MNARs) for the additional injectable medications represented by the new HCPCS codes below when these medications are administered in a freestanding or hospital-based dialysis center, an outpatient facility, a patient’s home or a physician’s office.¹

Generic Name Brand Name HCPCS
APREPITANT CINVANTI J0185
BENRALIZUMAB FASENRA J0517
BEVACIZUMAB-AWWB MVASI Q5107
BORTEZOMIB BORTEZOMIB J9044
BUROSUMAB-TWZA CRYSVITA J0584
CERLIPONASE ALFA BRINEURA J0567
COPANLISIB ALIQOPA J9057
DAUNORUBICIN; CYTARABINE LIPOSOMAL VYXEOS J9153
DURVALUMAB IMFINZI J9173
EDARAVONE RADICAVA J1301
FILGRASTIM-AAFI NIVESTYM Q5110
FOSNETUPITANT/PALONOSETRON AKYNZEO IV J1454
HYALURONAN OR DERIVATIVE DUROLANE J7318
HYALURONAN OR DERIVATIVE TRIVISC J7329
IBALIZUMAB-UIYK TROGARZO J1746
INOTUZUMAB OZOGAMICIN BESPONSA J9229
PEGFILGRASTIM-JMBD FULPHILA Q5108
ROLAPITANT VARUBI J2797
TILDRAKIZUMAB-ASMN ILUMYA J3245
VESTRONIDASE ALFA-VJBK MEPSEVII J3397

Review the revised list of injectable medications that currently 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 Medical necessity and appropriateness review is not required for injectable medications that are administered during an inpatient stay, or in an Emergency Room setting 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

Published on: December 28, 2018, 15:50 p.m. ET
Last updated on: December 28, 2018, 15:59 p.m. ET