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Update: Medication to be added to our Medical Injectables Program

In addition to the recently announced injectable medications to be included as part of our Medical Injectables Program (MIP), beginning with services to be provided on and after February 1, 2019, Magellan Rx Management℠

will also conduct medical necessity and appropriateness reviews (MNARs) for the additional injectable medication below when 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
PEGFILGRASTIM-CBQV UDENYCA Q5111

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

Magellan Rx Management is an independent company that supports Horizon BCBSNJ in the administration of medical necessity and appropriateness review for certain medical injectables.

Published on: January 16, 2019, 12:18 p.m. ET
Last updated on: January 16, 2019, 12:43 p.m. ET