Effective December 1, 2018, the following drug codes will not be allowed under the medical benefit for Commercial products. These drugs are routinely self-administered and therefore are considered covered under the member’s pharmacy benefit:

J0717 Certolizumab pegol inj 1mg
J1324 Enfuvirtide injection
J1438 Etanercept Injection
J1559 Injection, immune globulin (hizentra), 100 mg
J1595 Injection, glatiramer acetate, 20 mg
J1744 Injection, icatibant, 1 mg
J1830 Interferon Beta-1b / .25 Mg
J2170 Mecasermin injection
J2941 Injection, somatropin, 1 mg
J7639 Dornase Alpha Inhal Sol U D
J7682 Tobramycin Inhalation Sol
J7686 Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through DME, unit dose form, 1.74 mg
Q3026 Injection, Interferon Beta-1a, 11 Mcg for subcutaneous use
Q3027 Injection, interferon beta-1a, 1 mcg for intramuscular use
Q3028 Injection, interferon beta-1a, 1 mcg for subcutaneous use
Q4074 Iloprost, Inhalation Solution, Fda-Approved Final Product, Non-Compounded