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.
Code(s): J3590, J9999
Benefit: Pharmacy only, must be purchased through a specialty pharmacy
Notes: For treatment of moderate to severe symptoms of rheumatoid arthritis
Length of initial authorization: 3 months
Length of continuation authorization: 12 months