Empire expands specialty pharmacy prior authorization list

Effective for dates of service on and after November 1, 2018, the following specialty pharmacy codes from new or current medical policies or clinical UM guidelines will be included in our pre-service review process.

 

Empire’s pre-service clinical review of these specialty pharmacy drugs will be managed by AIM Specialty Health® (AIM), a separate company.

 

The following clinical guidelines or medical policies will be effective November 1, 2018:

 

Medical Policy or Clinical Guideline	Code	Drug	Comments
DRUG.00098	C9031 A9699 J9999	Lutathera®	New Policy
DRUG.00111	J3590	IlumyaTM	New Drug to Existing Policy
CG-DRUG-05	Q5105 Q5106	Retacrit®	New Drug to Existing Guideline
CG-DRUG-16	J3590	FulphilaTM	New Drug to Existing Guideline