BCBSGa expands Specialty Pharmacy Clinical Site of Care (Level of Care) drug list

Effective for dates of service on and after September 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 level of care review process.

 

BCBSGa’s level of care 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 (Level of Care) drug list and Clinical Site of Care (Level of Care) prior authorization clinical review FAQs for more information.

Medical Policy or Clinical Guideline	Drug	Code
CG-DRUG-09	CuvitruTM	J1555
DRUG.00081	Exondys 51TM	J1428
CG-DRUG-78	Fibryga®	J7178
DRUG.00093	KanumaTM	J2840
CG-DRUG-44	Krystexxa®	J2507
CG-DRUG-05	Mircera®	J0888
DRUG.00095	OcrevusTM	J2350
DRUG.00027	Prialt®	J2278
CG-DRUG-78	Rebinyn®	J7195
CG-DRUG-69	Stelara®	J3358
CG-DRUG-61	Supprelin LA®	J9226
CG-DRUG-16	Zarxio®	Q5101