Empire Expands specialty pharmacy clinically equivalent drug list

Effective for dates of service on and after January 1, 2019, the following specialty pharmacy codes from new or current medical policies or clinical UM guidelines will be included in our existing specialty pharmacy clinically equivalent review process. Please note, inclusion of NDC code on your claim will shorten the claim processing of drugs billed with a Not Otherwise Classified (NOC) code.

 

Empire’s clinically equivalent prior authorization 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	NDC Code
CG-DRUG-09	Cuvitru™	J1555	00944-2850-06 00944-2850-07 00944-2850-08 00944-2850-04 00944-2850-02 00944-2850-01 00944-2850-03 00944-2850-05
CG-DRUG-09	Hizentra®	J1559	44206-0451-01 44206-0452-02 44206-0455-10 44206-0454-04
CG-DRUG-09	HyQvia®	J1575	00944-2513-02 00944-2512-02 00944-2514-02 00944-2510-02 00944-2511-02