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 pre-service review process.

 

Empire’s pre-service 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 November 1, 2018:

 

Medical Policy or Clinical Guideline

Code

Drug

Comments

DRUG.00098

 

C9031

A9699

J9999

Lutathera®

 

New Policy

 

DRUG.00111

 

J3590

 

IlumyaTM

 

 

New Drug to Existing Policy

 

CG-DRUG-05

 

Q5105

Q5106

 

Retacrit®

 

New Drug to Existing Guideline

CG-DRUG-16

 

J3590

 

FulphilaTM

 

New Drug to Existing Guideline

 



Featured In:
August 2018 Empire Provider Newsletter