Aug 1, 2019 • Products & Programs / Pharmacy

In the June newsletter we announced the transition of the medical non-oncology specialty drug review process from AIM Specialty Health® (AIM) to Empire’s medical specialty drug review team, effective June 15, 2019. Here’s a reminder of the changes.

 

What has changed?

  • Beginning June 15, 2019, for all new specialty drug review requests and reauthorization specialty drug review requests that were previously performed by AIM, providers need to contact Empire’s medical specialty drug review team:
    • by phone at 1-833-293-0659
    • by fax at 1-888-223-0550 or
  • All inquiries about an existing request (initially submitted to AIM or Empire), peer-to-peer review, or reconsideration are being managed by Empire’s medical specialty drug review team.

 

What has not changed?

  • AIM continues to be responsible for performing medical oncology drug reviews for existing commercial medical benefit for our employer group business.
  • Specialty drug review processes not previously done by AIM remain unchanged.
  • Clinical criteria for medical non-oncology specialty drugs continues to reside on the clinical criteria page.
  • Post Service Clinical Coverage Reviews and Grievance and Appeals process and teams have not changed.

 

Here is a summary of the medical specialty drug changes: Beginning June 15, 2019

 

Action

Contact

 

Submit a new prior authorization request for medical specialty drug reviews

 

Submit a reauthorization request for a medical specialty drug review previously performed by AIM

Call Empire at 1-833-293-0659

 

or

 

Fax us at 1-888-223-0550 for

 

Inquire about an existing request (initially submitted to AIM or Empire), peer-to-peer review, or reconsideration

 

Call Empire at 1-833-293-0659

 

 


Featured In:
August 2019 Empire Provider News