Effective for dates of service on or after January 1, 2019, the following drug codes from new or current medical policies or clinical UM guidelines 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.  

 

Medical Policy or Clinical UM Guideline

Drug

HCPCS or CPT Code(s)

NDC Code

DRUG.00096

Trogarzo™

J3490, J3590

62064-0122-02



Featured In:
October 2018 Anthem New Hampshire Provider Newsletter