Designated specialty pharmacy network updates effective January 1, 2022

Material adverse change (MAC) notification

 

As we previously communicated, Empire BlueCross BlueShield’s (“Empire”) Designated Specialty Pharmacy Network requires providers who are not part of the Designated Specialty Pharmacy Network to acquire certain select specialty pharmacy medications administered in the hospital outpatient setting through CVS Specialty Pharmacy.   

 

This update is to advise of the following changes:

 

Effective for dates of service on and after January 1, 2022, the following specialty pharmacy medications will be added to the Designated Medical Specialty Pharmacy drug list. Accordingly, hospitals that are not in the Designated Specialty Pharmacy Network will be required to acquire these specialty medications administered in the hospital outpatient setting from CVS Specialty Pharmacy.

 

HCPCS	Description	Brand Name
J1554	Injection, immune globulin (asceniv), 500 mg	Asceniv
J7204	Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu	Esperoct
J7208	Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u.	Jivi
J7212	Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram	Sevenfact
J9144	Injection, daratumumab, 10 mg and hyaluronidase-fihj	Darzalex Faspro

 

To access the current Designated Medical Specialty Pharmacy drug list, please visit empireblue.com/provider, > select Find Forms > scroll down and select Pharmacy in the Category drop down.  The Designated Medical Specialty Pharmacy drug list may be updated periodically by Empire.

 

If you have questions or would like to discuss the terms and conditions to be included as a Designated Specialty Pharmacy Network provider, please contact your Empire Contract Manager.  Thank you for your continued participation in the Empire networks and the services you provide to our members.

 

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