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Medical Injectables Program Provider Questions and Answers

Horizon Blue Cross Blue Shield of New Jersey collaborates with Magellan Rx Management to manage our Medical Injectables Program (MIP). Magellan Rx Management, a specialty pharmaceutical management company, conducts medical necessity and appropriateness reviews (MNARs) for specific injectable medications in accordance with Horizon BCBSNJ’s medical policy criteria and guidelines when provided: at a freestanding or hospital-based dialysis center; in an outpatient facility; in a patient’s home; or in a physican’s office.

Select a category below or scroll down to review the questions and answers.

General Program Information

Medical Necessity and Appropriateness Review (MNAR)

Claims

Appeals

Hemophilia Drugs

In-network specialty pharmacy/home infusion providers

Injectable Medication Codes Subject to MrxM Claim Review/Editing

This information was last revised on June 10, 2021

Magellan Rx Management is an independent company that supports Horizon Blue Cross Blue Shield of New Jersey in conducting medical necessity and appropriateness reviews (MNARs) for specific injectable medications. Magellan Rx Management is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.

 

 

 

 

As part of the Medical Injectables Program (MIP), Magellan Rx Management (MRxM) conducts medical necessity and appropriateness review (MNAR) for hemophilia drugs. This program aims to ensure that patients are receiving the most appropriate dose of product based on each individual’s unique clinical situation. MRxM’s process in regard to hemophilia drugs includes an added component to be completed by the rendering provider prior to dispensing product to ensure appropriate assay management, inventory management and patient engagement is being provided.

Please review the questions and answers below for more information about the hemophilia services as part of the MIP.

 

Medical injectable drugs require special handling, and can cause higher out-of-pocket costs for members. Horizon Blue Cross Blue Shield of New Jersey wants to make sure our members get quality care, while lowering their out-of-pocket costs for these specialty medications.