Enbrel® (etanercept)

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): J1438

Benefit: Pharmacy only, must be ordered from a specialty pharmacy

Notes: Treatment of rheumatoid arthritis, juvenile RA, ankylosing spondylosis, plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis