Important Change to Injectable Drug List

Starting on January 12, 2018, the drugs listed in the chart below will be added to the list of drugs in EmblemHealth’s Injectable Drug Utilization Management Program.

That means you must get prior approval before writing prescriptions for these drugs, and get re-approval if these drugs were already prescribed to your patients.

For approvals, please use one of these options to contact Magellan Rx Management. You may ask for more than one approval at a time.

  • Call Magellan Rx Management at 800-424-4084, Monday through Friday, from 8 a.m. to 6 p.m.
  • Visit the Magellan Rx Management website at ih.magellanrx.com and select the "Providers and Physicians" icon.


Drug Brand Name Drug Generic Name Procedure Code
Actemra Tocilizumab J3262
Acthar_hp Corticotropin J0800
Aldurazyme Laronidase J1931
Benlysta Belimumab J0490
Berinert C1 esterase inhibitor (human) J0597
Cerezyme Imiglucerase J1786
Cimzia Certolizumab pegol J0717
Cinryze C1 esterase inhibitor (human) J0598
Elaprase Idursulfase J1743
Elelyso Taliglucerase alfa J3060
Entyvio Vedolizumab J3380
Eylea Aflibercept J0178
Fabrazyme Agalsidase beta J0180
Fusilev Levoleucovorin calcium J0641
Halaven Eribulin J9179
Hizentra Subcutaneous immune globulin J1559
Hyqvia Subcutaneous immune globulin J1575
Inflectra Infliximab-dyyb Q5102
Jevtana Cabazitaxel J9043
Kadcyla Ado-trastuzumab emtansine J9354
Keytruda Pembrolizumab J9271
Lemtrada Alemtuzumab J0202
Lucentis Ranibizumab J2778
Lumizyme Alglucosidase alfa J0221
Naglazyme Galsulfase J1458
Nplate Romiplostim J2796
Opdivo Nivolumab J9299
Perjeta Pertuzumab J9306
Prolia Denosumab J0897
Simponi aria Golimumab J1602
Stelara Ustekinumab J3357, Q9989
Tysabri Natalizumab J2323
Vpriv Velaglucerase alfa J3385
Xeomin Incobotulinumtoxina J0588
Xgeva Denosumab J0897
Yervoy Ipilimumab J9228