Products & Programs PharmacyCommercialMarch 31, 2019

Empire expands specialty pharmacy prior authorization 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 July 1, 2019, the following specialty pharmacy codes from the current guideline will be included in our prior authoirzation review process.

 

Please note, inclusion of NDC code on your claim will shorten the claim processing time of drugs billed with a Not Otherwise Classified (NOC) code.

 

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

 

The following clinical guideline will be effective July 1, 2019.

 

Clinical Guideline

HCPCS or CPT Code(s)

NDC Code(s)

Drug

CG-THER-RAD-03

A9699, C9408

71258-0015-02 71258-0015-22

Azedra®

PUBLICATIONS: April 2019 Empire Provider Newsletter