Appendix Z

Hospital Specialty Drugs

For Hospital Specialty Drugs and their corresponding codes for use in billing, refer to the Hospital Specialty Drugs List.

This is a resource list of the medication names and coverage standards of the current Hospital Specialty Drugs which are carved out from either the All-Patient Refined Diagnosis Related Group (APR-DRG) or the Enhanced Ambulatory Patient Group (EAPG) payment with an approved, member-specific prior authorization (PA).

PA forms and process documents can be found on the Physician-Administered Drugs web page. For the corresponding Healthcare Common Procedure Coding System (HCPCS) codes and National Drug Code (NDC) numbers for use in billing, refer to Appendix X: The HCPCS/NDC Crosswalk for billing Physician Administered Drugs (PADs).

Appendix Z Revision Log