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.
- When authorized, Rituxan® will be approved at a dose of 375mg/m2 for all indications except RA.
- Approved dosing for RA is 1,000mg every two weeks.
Length of initial authorization: 3 months.
Length of continuation authorization: 12 months.