CommercialOctober 1, 2018
Empire Expands specialty pharmacy clinically equivalent drug list
Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.
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 |
PUBLICATIONS: October 2018 Empire Provider Newsletter
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