New York
Provider Communications
New specialty pharmacy medical step therapy requirements
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