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1 ago, 2019

Drugs moving from the specialty pharmacy benefit to the medical benefit

As of 1 de octubre de 2019, for commercial members, the drugs listed below will move from the specialty pharmacy benefit to the medical benefit. These drugs will continue to require prior authorization (PA) through Prime Therapeutics, LLC, our pharmacy benefits manager. As a reminder, there are three mechanisms for submitting a PA: CoverMyMeds (www.covermymeds.com), fax (1-855-212-8110), and mail (Prime Therapeutics LLC Attn.: Clinical Review Dept. 1305 Corporate Center Dr., Eagan, MN 55121).

As with other drugs covered under the medical benefit, the drugs below are eligible for buy and bill. When billing for any of these drugs, the appropriate HCPC codes are included in the listing; administration codes will be required, as previously utilized.

Brand
Generic
HCPC
Bivigam
Immune globulin
J1556
Carimune
Immune globulin
J1556
Entyvio
Vedolizumab
J3380
Flebogamma
Immune globulin
J1572
Gamastan S/D
Immune globulin
J1560, J1460
Gammagard
Immune globulin
J1569
Gammagard S/D
Immune globulin
J1566, J1560, J1460
Gammaked
Immune globulin
J1561
Gammaplex
Immune globulin
J1557
Gamunex-C
Immune globulin
J1561
Inflectra
Biosimilar infliximab
Q5103
Octagam
Immune globulin
J1568
Privigen
Immune globulin
J1459
Remicade
Infliximab
J1745
Renflexis
Biosimilar infliximab
Q5104
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