New York
Provider Communications
Specialty pharmacy updates - October 2021
Specialty pharmacy updates for Empire BlueCross BlueShield (“Empire”) are listed below.
Prior authorization clinical review of non-oncology use of specialty pharmacy drugs is managed by Empire’s medical specialty drug review team. Review of specialty pharmacy drugs for oncology use is managed by AIM Specialty Health® (AIM), a separate company.
Please note that inclusion of National Drug Code (NDC) code on your claim will help expedite claim processing of drugs billed with a Not Otherwise Classified (NOC) code.
Site of care updates
Effective for dates of service on and after January 1, 2022, the following specialty pharmacy codes from current or new clinical criteria documents will be included in our site of care review process.
Access our Clinical Criteria to view the complete information for these site of care updates.
|
Clinical Criteria |
HCPCS or CPT Code(s) |
Drug |
|
*ING-CC-0062 |
Q5121 |
Avsola |
|
*ING-CC-0081 |
J0584 |
Crysvita |
|
*ING-CC-0162 |
J3241 |
Tepezza |
* Non-oncology use is managed by the medical specialty drug review team.
Quantity limit updates
Effective for dates of service on and after January 1, 2022, the following specialty pharmacy codes from current or new clinical criteria documents will be included in our quantity limit review process.
Access our Clinical Criteria to view the complete information for these quantity limit updates.
|
Clinical Criteria |
Drug |
HCPCS or CPT Code(s) |
|
ING-CC-0009 |
Lemtrada |
J0202 |
|
ING-CC-0011 |
Ocrevus |
J2350 |
|
ING-CC-0014 |
Avonex |
J1826 |
|
Q3027 |
||
|
Betaseron |
J1830 |
|
|
Copaxone |
J1595 |
|
|
Extavia |
J1830 |
|
|
Glatopa |
J1595 |
|
|
Plegridy |
J3590 |
|
|
C9399 |
||
|
Rebif |
J1826 |
|
|
Q3028 |
||
|
ING-CC-0020 |
Tysabri |
J2323 |
|
ING-CC-0029 |
Dupixent |
J3490 |
|
J3590 |
||
|
ING-CC-0038 |
Bonsity |
J3110 |
|
Forteo |
J3110 |
|
|
Tymlos |
C9399 |
|
|
J3490 |
||
|
ING-CC-0042 |
Siliq |
C9399 |
|
J3490 |
||
|
J3590 |
||
|
Taltz |
C9399 |
|
|
J3490 |
||
|
J3590 |
||
|
ING-CC-0048 |
Spinraza |
J2326 |
|
ING-CC-0062 |
Avsola |
Q5121 |
|
Erelzi |
J3590 |
|
|
Eticovo |
J3590 |
|
|
ING-CC-0066 |
Kevzara |
C9399 |
|
J3590 |
||
|
J3490 |
||
|
ING-CC-0075 |
Riabni |
Q5123 |
|
ING-CC-0077 |
Palynziq |
C9399 |
|
J3590 |
||
|
ING-CC-0082 |
Onpattro |
J0222 |
|
ING-CC-0156 |
Reblozyl |
J0896 |
|
ING-CC-0159 |
Scenesse |
J7352 |
|
ING-CC-0160 |
Vyepti |
J3032 |
|
ING-CC-0162 |
Tepezza |
J3241 |
|
ING-CC-0163 |
Durysta |
J7351 |
|
ING-CC-0170 |
Uplizna |
J1823 |
|
ING-CC-0172 |
Viltepso |
J1427 |
|
ING-CC-0173 |
Enspryng |
J3490 |
|
J3590 |
||
|
ING-CC-0174 |
Kesimpta |
C9399 |
|
J3490 |
||
|
J3590 |
||
|
ING-CC-0177 |
Zilretta |
J3304 |
|
ING-CC-0181 |
Veklury |
J3490 |
|
ING-CC-0183 |
Sogroya |
J3590 |
|
ING-CC-0185 |
Oxlumo |
J0224 |
|
ING-CC-0188 |
Imcivree |
J3490 |
|
J3590 |
||
|
ING-CC-0193 |
Evkeeza |
J3490 |
|
C9079 |
||
|
ING-CC-0194 |
Cabenuva |
J3490 |
|
C9077 |
Featured In:
October 2021 Newsletter