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Provider Manual

Home IV Drug Therapies

Last Updated on January 24, 2019

Effective 1/1/19 Security Health Plan (SHP) will be enhancing our home infusion benefits by increasing the number of medications included under the benefit.  The home infusion program not only offers high-quality care but also aids in lowering the total cost of care for our members. This benefit will expand access to home infusion medications and will allow our members the convenience of receiving infusions in the comfort of their own homes.

The 'Home Infusion Drugs and Prior Authorization' button identifies the   full list of home infusion eligible medications. Some of the home infusion medications will require prior authorization (PA) which will be managed through our specialty pharmacy medication partner,   Magellan.

Magellan Home Infusion PA List

Security Health Plan prior authorizes certain home IV drug therapies with affiliated vendors and conducts concurrent review of the same in order to determine medical necessity, contain costs through efficiency of care, actively manage members identified as high risk for complicated care needs, and evaluate appropriate use of resources to ensure optimal results for members.

To view prior authorization criteria or to submit an authorization to Magellan Rx click the ‘Submit a prior authorization’ link. 

Submit a prior authorization

Home Infusion Drugs and Prior Authorization

  • Column A – HCPCS: indicates the HCPCS associated with the drug listed in column C and D
  • Column B – Therapeutic Category: indicates the drug category
  • Column C - Brand Name: indicates the Brand Name of the drug
  • Column D - Generic Name: indicates the Generic Name of the drug
  • Column E – PA required: indicates if the drug requires Prior Authorization (PA). If PA is required an ‘X’ will be present. If no ‘X’ is present than PA is not required.
  • Column F – PSCE required: indicates if the drug is subject to post-service claim editing (PSCE). If PSCE is done an ‘X’ will be present. If no ‘X” is present than PSCE is not done. 

To prior authorize, call 1-800-548-1224.  

Procedure

  • The vendor will be responsible to call Security Health Plan to prior authorize home IV drug therapies if additional registered nurse visits are necessary.
  • The hospital discharge planner/social worker will contact Security Health Plan Customer Service to verify benefits. 
  • Security Health Plan Customer Service will verify benefits. A Security Health Plan staff member will inform the discharge planner/social worker of Security Health Plan’s preferred providers and instruct him/her to have the vendor call with physician’s orders.