BCBSGa expands specialty pharmacy clinical site of care (level of care) drug list

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 existing specialty pharmacy clinical site of care review process.

 

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

 

View the Clinical Site of Care drug list and Clinical Site of Care prior authorization clinical review FAQs for more information.

Medical Policy or Clinical Guideline	Drug	Code
CG-DRUG-78	HemlibraTM	Q9995
CG-DRUG-89	SublocadeTM	Q9991 Q9992
CG-DRUG-89	Probuphine®	J0570
CG-DRUG-05	Retacrit®	Q5106