Medical Benefit Management Program Specialty Drug List
If you have questions, please call (877) 273-2122.
Claims where there is a prior authorization requirement will have claims checked against the quantities and approvals obtained in the prior authorization.
Billing for any drug or biologic acquired with a 340B drug pricing program discount requires the use of JG or TB modifier, effective January 1, 2018.
This drug list is subject to change at any time in between quarterly updates.