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Medical Injectables Program Updates: June 2023

Horizon collaborates with Magellan Rx Management (MRxM) to administer its Medical Injectables Program (MIP). As part of our shared commitment to help ensure that the medications our members need are medically necessary and cost effective, the following changes will be made to our MIP.

Injectable Medication Codes Subject to MRxM Claim Review/Editing

The medical injectable drug codes listed below, when included on claims for services rendered on and after June 18, 2023 will also be reviewed by MRxM to ensure the billing details are appropriate per our medical policy guidelines. These codes are not subject to MNAR.
Brand Name Generic Name HCPCS CODE
Cimerli™ ranibizumab-eqrn Q5128
Pemetrexed (generic mfd. by Hospira) pemetrexed (Hospira) J9294
Pemetrexed (generic mfd. by Accord) pemetrexed (Accord) J9296
Pemetrexed (generic mfd. by Sandoz) pemetrexed (Sandoz) J9297

Injectable Medications subject to Medical Necessity and Appropriateness Review (MNAR)

Please note that a number of drugs in this program have recently been assigned HCPCS Level II codes effective April 1, 2023. Please review the MNAR Code List to ensure that you are using the appropriate codes when requesting reviews or submitting claims.

If you have any questions, please contact your Network Specialist or Ancillary Contracting Specialist.

Magellan Rx Management℠ is a service mark of Magellan Health, Inc. Magellan Rx Management is an independent company that supports Horizon Blue Cross Blue Shield of New Jersey in the administration of conduct medical necessity and appropriateness review (MNAR) for certain medical injectable drugs. Magellan Rx Management is independent from and not associated with Horizon Blue Cross Blue Shield of New Jersey.

This web page contains prescription brand name drugs that are registered marks or trademarks of pharmaceutical manufacturers that are not affiliated with Magellan Rx Management, Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross Blue Shield Association.

Published on: March 20, 2023, 06:32 a.m. ET
Last updated on: March 15, 2023, 06:34 a.m. ET