Effective for dates of service on and after November 1, 2018, the following specialty pharmacy codes from new or current medical policies or clinical UM guidelines will be included in our existing specialty pharmacy clinical site of care review process.

 

Empire’s prior authorization clinical review of these specialty pharmacy drugs will be managed by AIM Specialty Health® (AIM), a separate company.

 

View the Clinical Site of Care drug list and Clinical Site of Care pre-service clinical review FAQs for more information.

 

Medical Policy or

Clinical Guideline

Drug

       Code     

CG-DRUG-78

HemlibraTM

Q9995

CG-DRUG-89

SublocadeTM

Q9991

Q9992

CG-DRUG-89

Probuphine®

J0570

CG-DRUG-05

Retacrit®

Q5106

 



Featured In:
August 2018 Empire Provider Newsletter