Effective for dates of service on and after January 1, 2019, the following specialty pharmacy codes from new or current medical policies or clinical UM guidelines will be included in our existing specialty pharmacy level of care review process.

 

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

 

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

 

Medical Policy or

Clinical UM Guideline

 

Drug

 

HCPCS or CPT Code

 

NDC Code

 

CG-DRUG-16

Fulphila™

Q5108

67457-0833-06

 



Featured In:
October 2018 Empire Provider Newsletter