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Provider Manual

Home IV Drug Therapies

Last Updated on October 17, 2018

Starting 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 the infusions in the comfort of their own homes. Please check our website for a 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.

Generic Names

Brand Names

J0129 Abatacept ORENCIA®
J0180 Agalsidase Beta FABRAZYME®
J0202 Alemtuzumab LEMTRADA®
J0221 Alglucosidase Alfa LUMIZYME®
J0490 Belimumab BENLYSTA®
J0597 C1 Esterase Inhibitor BERINERT®
J0598 C1 Esterase Inhibitor CINRYZE®
J0596 C1 Esterase Inhibitor, Recomb RUCONEST®
J0717 Certolizumab CIMZIA®
J0897 denosumab PROLIA®
J0897 denosumab XGEVA®
J1300 Eculizumab SOLIRIS®
J1325 Epoprostenol VELETRI®
J1428 Eteplirsen EXONDYS 51®
J1458 Galsulfase NAGLAZYME®
J1602 Golimumab SIMPONI ARIA®
J1743 Idursulfase ELAPRASE®
J1575 Igg/Hyaluronidase,Recombinant HYQVIA®
J1786 Imiglucerase CEREZYME®
J1572 Imm Glob G (Igg)/Sorb/Iga 0-50 FLEBOGAMMA DIF®
J1557 Immun Glob G(Igg)/Gly/Iga 0-50 GAMMAPLEX®
J1556 Immun Glob G(Igg)/Gly/Iga Ov50 BIVIGAM®
J1569 Immun Glob G(Igg)/Gly/Iga Ov50 GAMMAGARD LIQUID®
J1559 Immun Glob G(Igg)/Pro/Iga 0-50 HIZENTRA®
J1459 Immun Glob G(Igg)/Pro/Iga 0-50 PRIVIGEN®
J1566 Immun Glob G/Gly/Gluc/Iga 0-50 GAMMAGARD S-D®
J1568 Immun Globg(Igg)/Malt/Iga Ov50 OCTAGAM®
J1566 Immun Globg(Igg)/Sucr/Iga Ov50 CARIMUNE NF NANOFILTERED®
J1561 Immune Globul G/Gly/Iga Avg 46 GAMMAKED®
J1561 Immune Globul G/Gly/Iga Avg 46 GAMUNEX-C®
J1745 Infliximab REMICADE®
Q5104 Infliximab-Abda RENFLEXIS®
Q5103 Infliximab-Dyyb INFLECTRA®
J1931 Laronidase ALDURAZYME®
J2182 Mepolizumab NUCALA®
J2323 Natalizumab TYSABRI®
J2326 Nusinersen SPINRAZA®
J2357 Omalizumab XOLAIR®
J2469 Palonosetron Aloxi
J2507 Pegloticase KRYSTEXXA®
J2786 Reslizumab CINQAIR®
J3060 Taliglucerase ELELYSO®
J3262 Tocilizumab ACTEMRA®
J3285 Treprostinil REMODULIN®
J3358 Ustekinumab STELARA®
J3380 Vedolizumab ENTYVIO®
J3385 Velaglucerase VPRIV®
J9371 Vincristine Liposomal MARQIBO®

Security Health Plan Infusion list

Brand Names

Generic Names

J7323 Euflexxa hyaluronate sodium
J7328 GelSyn-3 hyaluronate sodium
J7320 GenVisc 850 hyaluronate sodium
J7321 Hyalgan hyaluronate sodium
J7321 Supartz hyaluronate sodium
J7321 Supartz FX hyaluronate sodium
J7321 Visco-3 hyaluronate sodium
J3490 Durolane hyaluronic acid
J7327 Monovisc hyaluronic acid
J7324 Orthovisc hyaluronic acid
J7325 Synvisc-One hylan polymers A and B
J7322 Hymovis Hymovis
J7317 Synojoynt sodium hyaluronate
J7325 Synvisc sodium hyaluronate
J3490 Trivisc sodium hyaluronate
J7326 Gel-One
Iron
Anitibiotic- Antiviral Intraenous infusion
chemotherapy
parenteral nutrition
intravenous immuogloulin- subcutaneous immuoglobulin

Security Health Plan Post Service Claim Edits

Brand Names

Generic Names

J3590 Crysvita burosumab-twza
C9015 Haegarda® C1 esterase inhibitor - effective 1/1/2019
J3590 Dupixent dupilumab
J9999 Imfinzi durvalumab
J3490 Aimovig erenumab-aooe
J3490 Akynzeo fosnetupitant/palonosetron
J3490 Takhzyro® lanadelumab-flyo    - effective 1/1/2019
Zometa® & Reclast® zoledronic acid

 

Prior authorization forms

Antibiotic - Antiviral Intravenous Infusion
Home Infusion - Chemotherapy
Parenteral Nutrition Home Infusion
Intravenous Immunoglobulin - Subcutaneous Immunoglobulin Infusion
IV Infusion Therapy

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 physicians orders.