Specialty Pharmacy Program expands Level of Care Reviews to NYC Hospital PPO Members

What’s new beginning with dates of service on and after March 1, 2020?

Empire’s Specialty Pharmacy Level of Care Program launched in July 2016 and was communicated in our April 2016 newsletter.  Empire is expanding the Specialty Pharmacy Level of Care Program, effective March 1, 2020 to include NYC Hospital PPO plan membership.  Specialty Drugs inclusive in the program will be reviewed for both clinical appropriateness and the level of care against health plan clinical criteria (CG-Med-83, CG-DRUG-53) for dates of service beginning March 1, 2020.

 

Physician offices that currently administer Specialty Drugs in the office setting are not impacted by this change.   We encourage you to discuss with members their level of care options, such as physician office, infusion center or home infusion therapy, as appropriate.