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.
Notes: Per 10 mg; for treatment of rheumatoid arthritis, ankylosing spondylosis, Crohn’s disease, ulcerative colitis, plaque psoriasis, psoriatic arthritis, or ankylosing spondylitis