Specialty pharmacy site of care reviews for NYSHIP Empire Plan members - effective July 1, 2023

Effective July 1, 2023, specialty pharmacy site of care reviews will be required for New York State Health Insurance Program (NYSHIP) Empire Plan members. Empire Plan members are billed under the dedicated prefix YLS. Empire BlueCross BlueShield administers the Empire Plan Hospital Program. Pre-determination clinical review of non-oncology use of specialty pharmacy drugs is managed by the clinical team dedicated to Empire Plan members:

• Access our Clinical Criteria to view the complete information for these predetermination requests.

Important note: Currently your Empire Plan patients may receive infusions of these medications without prior authorization or predetermination of benefits. As of the effective date below, it is strongly recommended you request a predetermination of benefits for your patients’ continued infusions of these medications.

Effective for dates of service on and after July 1, 2023, the specialty pharmacy codes from current or new Clinical Criteria documents will be included in our site of care review process:

• Access our Clinical Criteria to view the complete information for these site of care updates and to view the complete list of drugs subject to site of care review.