Portrazza® (necitumumab)

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): J9295

Benefit: Medical

Notes:

  • 1 mg, chemotherapy agent
  • Non-formulary,  not covered for commercial or Medicaid plans