Specialty pharmacy pre-service clinical review list expanded January 1, 2019

 

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

Please note: inclusion of NDC code on claims will help expedite claim processing of drugs billed with a not otherwise classified (NOC) code.

Pre-service clinical review of these specialty pharmacy drugs will be managed by AIM Specialty Health® (AIM®), a separate company.  

 

Medical Policy or Clinical UM Guideline	Drug	HCPCS or CPT Code(s)	NDC Code
DRUG.00096	Trogarzo™	J3490, J3590	62064-0122-02