Home IV Drug Therapies
Effective 1/1/2021 Security Health Plan will be enhancing our home infusion benefit for select product lines. 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.
Our ‘Medical pharmacy’ page identifies home infusion eligible medications. To view the full list of home infusion eligible medications select ‘Home Infusion’ from the Category drop down. You may also search for a select medication by entering the drug code or generic/brand drug name in the ‘Search’ field. Medications that are allowed to be administered in the home setting will be indicated with ‘Home infusion eligible’. Some of the home infusion medications will require prior authorization (PA) which will be managed through our specialty pharmacy medication partner, Magellan. Drugs that require PA will be indicated with ‘Prior Authorization is required’.
Please note: The Security Health Plan prior authorization requirements apply regardless of whether or not Security Health Plan is the member’s primary or secondary coverage. If the claim will eventually be billed to Security Health Plan (whether primary or secondary), prior authorization will be required for payment.
Prior authorization requirements apply to all Security Health Plan coverage lines: Security Health Plan Medicare products, Security Administrative Services (SAS), Security Health Plan BadgerCare Plus, large and small employer plans and individual and family plans both on and off the Federally-facilitated Marketplace.
Prior authorization requirements apply to services requested directly from Security Health Plan and to those requested from vendors contracted by Security Health Plan such as, but not limited to, eviCore, NaviHealth, Magellan or Northwood for Security Health Plan members.
Prior authorization should be sought for workers’ compensation/liability cases, to avoid denials in the event workers’ compensation/liability coverage is denied or exhausted.
If a Security Health Plan member is being seen for an injury believed to be work-related and covered by workers’ compensation, the services should be prior authorized at the same time the service is provided, to ensure coverage in the event the workers’ compensation claim is denied.
Home infusion services must be provided by an affiliated home infusion provider to be covered. For Commercial product lines that have an out of network benefit, members are eligible to see any licensed provider. Security Health Plan recommends you use an affiliated home infusion provider to keep the cost of care lower for our members. Lab draws and/or lab processing are part of the home infusion per diem and are all inclusive. Lab draws and/or lab processing will not be separately billable by the Home Infusion provider or Laboratory used for processing.Security Health Plan has contracted with the following home infusion providers:
NOTE: SimplyOne narrow network providers are Accredo, Fairview and OptionCare/BioScript.
- Specialty medications:
- Phone: (866) 759-1557
- Phone: (612) 672-2233
- Phone (715) 301-7160
- Traditional medications:
- (612) 672-2233
- Option Care/BioCare
- (888) 256-7234
- Phone (715) 301-7160
Procedure for ordering providers
- Use the ‘Medical pharmacy’ page to determine if the medication is Home Infusion eligible
- Contact one of the affiliated home infusion providers listed above to initiate treatment
- If medication requires PA the home infusion provider will initiate the PA through 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 determine if a medication requires PA refer to the ‘Medical pharmacy’ page and search for the desired medication. If the drug requires PA it will be indicated with ‘Prior authorization is required’.
To view prior authorization criteria or to submit an authorization to Magellan Rx click the ‘Submit a prior authorization’ link.