State & FederalMedicaidApril 1, 2022

Provider administered drugs

Medicaid

 

To better serve the members of Amerigroup Community Care and to ensure members benefits are optimized, members who are taking certain provider administered drugs through their pharmacy benefit will be directed to access them exclusively under their medical benefit.

 

Impacted members will receive a letter advising of the change in drug coverage. The below list of provider administered drugs will be covered under the medical benefit for dates of service December 1, 2021, and beyond:

 

HCPCS or CPT® code(s)

Drug

J0256

ARALAST NP

Q5121

AVSOLA

J9023

BAVENCIO

J0490

BENLYSTA

J0179

BEOVU

J0598

CINQAIR

J0586

DYSPORT

J9217

ELIGARD

J1325

EPOPROSTENOL SODIUM

J0178

EYLEA

J0180

FABRAZYME

J1325

FLOLAN

J0257

GLASSIA

J9173

IMFINZI

Q5103

INFLECTRA

J1290

KALBITOR

J9271

KEYTRUDA

J9119

LIBTAYO

J2778

LUCENTIS

J0221

LUMIZYME

 

HCPCS or CPT® code(s)

Drug

J9217

LUPRON DEPOT (1-MONTH)

J9217

LUPRON DEPOT (3-MONTH)

J1950

LUPRON DEPOT (3-MONTH)

J9217

LUPRON DEPOT (4-MONTH)

J9217

LUPRON DEPOT (6-MONTH)

J2503

MACUGEN

Q5107

MVASI

J0587

MYOBLOC

C9494

OCREVUS

J9299

OPDIVO

J0897

PROLIA

J3489

RECLAST

J1745

REMICADE

J3285

REMODULIN

Q5104

RENFLEXIS

J9312

RITUXAN

J0596

RUCONEST

Q5119

RUXIENCE

J2354

SANDOSTATIN LAR DEPOT

J1602

SIMPONI ARIA

J1930

SOMATULINE DEPOT

C9483

TECENTRIQ

J3315

TRELSTAR

J3315

TRELSTAR MIXJECT

J0490

TREPROSTINIL

Q5115

TRUXIMA

HCPCS or CPT® code(s)

Drug

J2323

TYSABRI

J1325

VELETRI

J0588

XEOMIN

J0897

XGEVA

J9228

YERVOY

J0256

ZEMAIRA

Q5118

ZIRABEV

J9202

ZOLADEX

Q2051

ZOLEDRONIC ACID

J3487

ZOLEDRONIC ACID

J3489

ZOMETA

 

We appreciate your support and look forward to your assistance in assuring that our Amerigroup members’ drug benefit coverage is provided in a clinically appropriate fashion. If you have questions, please contact your local Network Relations representative.

 

ANV-NU-0323-22

ANV-NU-0268-21

PUBLICATIONS: April 2022 Anthem Provider News - Nevada