No prior authorization required for:
- Emergency room
- 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.
- Medical benefit if administered by health professional
- Pharmacy benefit if self-injected
Notes: Per 1 mg; treatment of moderate to severe Crohn's disease and rheumatoid arthritis.