Medical Injectables Program
Horizon Blue Cross Blue Shield of New Jersey is committed to providing your patients, our members, with access to high-quality health care services that are consistent with nationally recognized clinical criteria and guidelines.
As part of that commitment, Horizon BCBSNJ collaborates with Magellan Rx Management, a specialty pharmaceutical management company to administer our Medical Injectables Program (MIP). Magellan Rx Management conducts medical necessity and appropriateness reviews (MNARs) for specific injectable medications including hemophilia drugs. Magellan Rx Management also reviews claims that include certain medical injectable drug codes to help ensure that the billing details are appropriate per our medical policy guidelines. These codes are not subject to MNAR.
List of injectable medications and HCPCS codes included as part of our MIP
Hemophilia Case Review Form
As part of this program, rendering providers of hemophilia products must complete a Hemophilia Case Review Form prior to the dispensing of the first dose and prior to the dispensing of subsequent doses that will document:
- Original prescription information
- Requested amount to be dispensed (including specific vial sizes
- Vial sizes available
- Patient clinical history (including patient product inventory and bleed history)
This case review process will help ensure appropriate administration of medication, assay management, inventory management and patient engagement, as well as helping ensure that bleed history is appropriately documented and tracked.
RESOURCES
- MIP Code List
- Medical Injectables Program FAQs
- Hemophilia Drugs FAQs
- Access our Medical Policies Manual to view clinical criteria and guidelines related to medical injectables, including hemophilia products.
- Review the Quick Start Guide; step-by-step instructions to help ordering physicians and their staff obtain medical necessity determinations for the specialty medical injectable medications included in this program.
- Review the Quick Reference Guide which provides the high-level information you need to know about Horizon BCBSNJ’s MIP.
