New York
Provider Communications
Empire expands specialty pharmacy prior authorization list
Effective for dates of service on and after November 1, 2018, the following specialty pharmacy codes from new or current medical policies or clinical UM guidelines will be included in our pre-service review process.
Empire’s pre-service clinical review of these specialty pharmacy drugs will be managed by AIM Specialty Health® (AIM), a separate company.
The following clinical guidelines or medical policies will be effective November 1, 2018:
Medical Policy or Clinical Guideline |
Code |
Drug |
Comments |
DRUG.00098
|
C9031 A9699 J9999 |
Lutathera®
|
New Policy
|
DRUG.00111
|
J3590
|
IlumyaTM
|
New Drug to Existing Policy
|
CG-DRUG-05
|
Q5105 Q5106
|
Retacrit®
|
New Drug to Existing Guideline |
CG-DRUG-16
|
J3590
|
FulphilaTM
|
New Drug to Existing Guideline |
Featured In:
August 2018 Empire Provider Newsletter