Specialty pharmacy updates - December 2022

Material Adverse Change (MAC)

Specialty pharmacy updates for Empire BlueCross BlueShield are listed below.

 

Prior authorization clinical review of nononcology use of specialty pharmacy drugs is managed by Empire’s Medical Specialty Drug Review team. Review of specialty pharmacy drugs for oncology use is managed by AIM Specialty Health_® (AIM), a separate company.

 

Inclusion of the National Drug Code (NDC) code on your claim will help expedite claim processing of drugs billed with a not otherwise classified (NOC) code.

 

Step therapy updates

Clinical Criteria ING-CC-0182 currently has a step therapy preferring Ferrlecit^®, Infed^®, and Venofer^®.

 

Effective for dates of service on and after March 1, 2023, the status of Infed in current criteria documents will be changing in our existing specialty pharmacy medical step therapy review process. This update is to notify that Infed will change to non-preferred.

 

Also, effective for dates of service on or after December 1, 2022, Feraheme^® (ferumoxytol) will change to preferred for both brand and generic.

 

Access our Clinical Criteria to view the complete information for these step therapy updates.

 

Clinical Criteria	Status	Drug	HCPCS or CPT® code(s)
ING-CC-0182	Nonpreferred	Infed (iron dextran)	J1750
ING-CC-0182	Nonpreferred	Injectafer® (ferric carboxymaltose)	J1439
ING-CC-0182	Nonpreferred	Monoferric® (ferric derisomaltose)	J1437
ING-CC-0182	Preferred	Feraheme (ferumoxytol)	Q0138
ING-CC-0182	Preferred	Ferrlecit (sodium ferric gluconate/sucrose complex)	J2916
ING-CC-0182	Preferred	Venofer® (iron sucrose)	J1756

 

NYBCBS-CM-012641-22-CPN12421