Effective immediately, the following specialty pharmacy codes from new or current coverage guidelines will be removed from our existing specialty pharmacy clinical site of care review process.

 

Please note, these drugs will continue to require prior authorization clinical review for medical necessity.

 

Medical Policy or

Clinical Guideline

Drug

Code

CG-DRUG-100

Actimmune®

J9216

DRUG.00086

Increlex®

J2170

CG-DRUG-60

Firmagon®

J9155

 



Featured In:
August 2018 Empire Provider Newsletter