Pre-service clinical review drug list changes effective September 1, 2018

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 pre-service clinical review process.

 

Pre-service 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 September 1, 2018:

Clinical UM Guideline or Medical Policy	Drug Name	Drug Code(s)
CG-DRUG-44	Krystexxa®	J2507
CG-DRUG-89	Sublocade™	J3490, Q9991, Q9992