Benlysta® (belimumab)

Authorization forms (both SC and IV formulations)

Traditional, Optimized & Medicaid (03/2019) 

Medicare Part B (01/2019)

No prior authorization required for:

  • Emergency room
  • Inpatient
  • Skilled nursing facility

Injectable auth/billing notes:

Medications billed with miscellaneous codes will be reviewed. Explanatory notes must accompany the claim.

Priority Health Medicare applies CMS local coverage determination criteria when available for Part B drugs.

Code(s): J0490

Benefit: Medical or Pharmacy

Notes: Treatment of systemic lupus erythematosus