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

Effective for dates of service on or after July 1, 2019, the following drug code from the current clinical guideline 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.  

 

Clinical Guideline	HCPCS Codes	NDC Codes	Drug
CG-THER-RAD-03	A9699, C9408	71258-0015-02, 71258-0015-22	Azedra®