New York
Provider Communications
New specialty pharmacy medical step therapy requirements
Effective for dates of service on and after October 1, 2022, the following specialty pharmacy codes from current or new Clinical Criteria documents will be included in our existing specialty pharmacy medical step therapy review process. Step therapy review will apply upon precertification initiation or renewal in addition to the current medical necessity review of all drugs noted in the chart.
Featured In:
September 2022 Newsletter
The Clinical Criteria are publicly available on our provider website. Visit the Clinical Criteria website to search for specific Clinical Criteria.
|
Clinical Criteria |
Status |
Drug(s) |
HCPCS codes |
|
ING-CC-0166 |
Preferred |
Kanjinti |
Q5117 |
|
ING-CC-0166 |
Non-preferred |
Herceptin |
J9355 |
|
ING-CC-0166 |
Non-preferred |
Herzuma |
Q5113 |
|
ING-CC-0166 |
Non-preferred |
Ogivri |
Q5114 |
|
ING-CC-0166 |
Non-preferred |
Ontruzant |
Q5112 |
|
ING-CC-0166 |
Non-preferred |
Trazimera |
Q5116 |
Featured In:
September 2022 Newsletter