Effective July 15, 2024- EmblemHealth will update their site of care policy and add 170 more injectable and infusion drugs to the list.
This change will apply to the commercial line of business and for all age groups.
The change is to help bring down the members’ cost sharing (out of pocket costs) and provide an access to the ongoing maintenance of infusion therapy.
The following is a partial list of these medications:
Note: for a full list of medications and the pdf version of site of care policy please visit – https://www.emblemhealth.com/providers/news/infusions-and-injectables-updates-policy-202404
These medications will still require prior authorization but will no longer be covered when administered in a hospital setting.
Instead the medications will be covered in the following place of service:
POS 11- Office
POS 12- Home
Ambulatory Infusion Suites- (POS 24, POS 49, or POS 12 with Modifier SS)
Exceptions for members that are receiving their first dosage may be requested with justifiable medical necessity.
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