Site of Administration Program for Infusion/Injectable Medications

Since 2018, Horizon has managed a Site of Administration Program for Infusion/Injectable Medications that supports compliance with the guidelines of our Site of Service for Administration for Infusion and Injectable Prescription Medications medical policy.

Through this program, claims submitted for the administration of certain infusion and injectable therapy drugs are considered medically necessary and eligible for reimbursement when these services are administered in a patient's home, an office setting, or a freestanding ambulatory infusion center.

• Review the list of infusion/injectable medications included as part of this program.

When certain criteria are met, claims submitted for the administration of these infusion/injectable therapy drugs in a hospital outpatient setting may be considered medically necessary. We encourage you to review the guidelines of this medical policy for complete information.

This program, as well as this medical policy's guidelines, applies to all Horizon plans/products, except:

• BlueCard® plans (please contact the member's local BCBS Plan regarding requirements)
• Braven Health℠ Medicare Advantage plans
• Federal Employee Program® (FEP®) plans
• Horizon NJ Health plans: Medicaid Managed Care, NJ Family Care, Horizon NJ TotalCare (HMO D-SNP), Managed Long Term Services & Supports plans

• ADDING NEW-TO-MARKET DRUGS

  Below is information about the process we will follow in regard to the inclusion of new-to-market (NTM) drugs in this program.

  • An online news item will be posted within News & Legal Notices to provide at least 30 days' advance notice before a NTM drug is added to this program.
  • The NTM drug (and the corresponding not-otherwise-classified (NOC) HCPCS code and National Drug Code (NDC) number will be added to our list of infusion/injectable medications included as part of this program.
  • When a procedure code is assigned to a NTM drug included in our Site of Service program, we will update the online list to replace the NOC code and NDC number.
  • The assignment of a HCPCS code to an NTM drug included in this program will not be announced. Providers should access the publicly available HCPCS Quarterly Update information on CMS.gov to understand when HCPCS codes are assigned.

• MEMBER SUPPORT

  As part of this program, we collaborate with Magellan Rx Management (MRxM) to identify alternate locations for the safe and convenient administration of the infusion/injectable medications included as part of this program.

  Through MRxM’s Infusion Referral Center (IRC), registered nurse care managers who are experienced in helping patients manage health conditions that require injectable and infusion drug therapies provide patients with information about their condition, their drug therapy and their treatment location options.

  • Nurse care managers are available Monday through Friday, between 8 a.m. and 5 p.m., Eastern Time by calling 1-800-424-1867

  Members may also email IRC nurse care managers at InfusionReferralCenterHZN@MagellanHealth.com