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

 

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

 

The following clinical guidelines or medical policies will be effective September 1, 2018:

 

Medical Policy or Clinical Guideline

Code

Drug

Comments

CG-DRUG-44

 

J2507

 

Krystexxa®

 

Existing Guideline

 

CG-DRUG-89

 

J3490

Q9991

Q9992

Sublocade TM

 

 

New Drug to Existing Guideline

 



Featured In:
June 2018 Empire Provider Newsletter