Reminder: Specialty Pharmacy Program expands Level of Care Reviews to NYC Hospital PPO Members
Empire BlueCross BlueShield’s (“Empire”) Specialty Pharmacy Level of Care Program launched July 2016 and was communicated in our April 2016 newsletter. Per our December 2019 newsletter, Empire is expanding the Specialty Pharmacy Level of Care Program, to include NYC Hospital PPO plan membership. Specialty Drugs inclusive in the program will be reviewed for both clinical appropriateness and the level of care against health plan clinical criteria (CG-Med-83) for dates of service beginning November 1, 2020.
Physician offices that currently administer Specialty Drugs in the office setting are not impacted by this change. We encourage you to discuss with your patients their level of care options, such as physician office, infusion center or home infusion therapy, as appropriate.
November 2020 Empire Provider News