Anzemet (granisetron)

Authorization forms

Anzemet tablets:

Medicare Part B vs. Part D determination (09/2018)

 

Anzemet solution:

(Prior authorization required for home infusion providers only)

Home Infusion Services Authorization Request

Code(s): J1260

Benefit: Medical

Notes: Per 10 mg, antiemetic. PA required for HINF provider ONLY.

Criteria for coverage: See PA form. May be covered under Medicare Part B or Part D depending on circumstances.