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 prior authorization review process.

Please note, inclusion of NDC code on your claim will shorten the claim processing of drugs billed with a Not Otherwise Classified (NOC) code.

 

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 January 1, 2019:

 

Coverage or Clinical UM Guideline

HCPCS/CPT Code

NDC Code

 

Drug

DRUG.00096

J3490

J3590

62064-0122-02

Trogarzo™

 



Featured In:
October 2018 Empire Provider Newsletter