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NOVEMBER SPECIAL EDITION 2020 News for Providers from HealthPartners Professional Services and Hospital Network Management

Administra tive

3M Employer Plan Specialty Drug Update

HealthPartners administers the 3M employer plan in Minnesota and western Wisconsin. Starting 1/1/2021, 3M will be moving their specialty drug administration to Archimedes Rx. This change will affect 3M employees and dependents that receive specialty drugs covered through their pharmacy benefit and some specialty drugs that are professionally administered and reimbursed through their medical benefit. Starting 1/1/2021, authorizations for these medications will be required through Archimedes Rx, not HealthPartners. If you submit an authorization request through HealthPartners, you will be redirected to Archimedes. This change does not affect any medications administered in the hospital inpatient setting. This benefit change affects only 3M employees and dependents ; no other HealthPartners members are affected by this change. The 3M Plan Group Number is 3190. Below is a list of the medical benefit, professional administered specialty medications that will require authorization through Archimedes. Questions can be directed to Archimedes Rx at 1-888-506-1180. You can find information about Archimedes Rx at archimedesrx.com.

MEDICAL BENEFIT SPECIALTY DRUG LISTING:

HCPC Code Generic Name Brand Description J0490 Benlysta Q2044 Belimumab Benlysta C9249 Cimzia J0717 Certolizumab Pegol Cimzia J0718 Certolizumab Pegol Cimzia C9481 Cinqair J2786 Reslizumab Cinqair J3380 Entyvio J0178 Eylea J0180 Agalsidase beta Fabrazyme C9466 Fasenra J0517 Benralizumab Fasenra J7317 Sodium Hyaluronate (Viscosupplement) Hyalgan J7319 Sodium Hyaluronate (Viscosupplement) Hyalgan J7321 Sodium Hyaluronate (Viscosupplement) Hyalgan

MEDICAL BENEFIT SPECIALTY DRUG LISTING (CONTINUED):

HCPC Code Generic Name Brand Description Q4083 Sodium Hyaluronate (Viscosupplement) Hyalgan J7322 Hyaluronan Hymovis Q5102 -dyyb Inflectra Q5103 Infliximab-dyyb Inflectra J0202 (MS) Lemtrada J2778 Ranibizumab Lucentis J2503 Pegaptanib Sodium Macugen J1725 Hydroxyprogesterone Caproate Makena J1726 Hydroxyprogesterone Caproate Makena J1729 Hydroxyprogesterone Caproate Makena Q9885 Hydroxyprogesterone Caproate Makena Q9986 Hydroxyprogesterone Caproate Makena J7327 Hyaluronan Monovisc C9473 Nucala J2182 Mepolizumab Nucala C9494 Ocrevus J2350 Ocrelizumab Ocrevus J7324 Hyaluronan OrthoVisc Q4086 Hyaluronan OrthoVisc C9493 Edaravone Radicava J1301 Edaravone Radicava Q3028 Beta-1a Rebif J1745 Infliximab Remicade Q5104 Infliximab-abda Renflexis C9489 Nusinersen Spinraza J2326 Nusinersen Spinraza J7325 Hylan Synvisc Q4084 Hylan Synvisc J7329 Sodium Hyaluronate (Viscosupplement) TriVisc J3396 Verteporfin Visudyne J0775 Collagenase Clostridium Histolyticum Xiaflex J2357 Xolair

If you have questions regarding the content of this newsletter, please contact the person indicated in the article or call your HealthPartners Service Specialist. If you don’t have his/her phone number, please call 952-883-5589 or toll-free at 888-638-6648. This newsletter is available online at healthpartners.com/fastfacts.

Fast Facts Editors: Mary Jones and David Ohmann

Fast Facts November Special Edition 2020 Page 2