No prior authorization required for Medicare
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.
Treatment of metastatic breast and prostate cancer
See PA form for criteria for Commercial and Medicaid
No PA for Medicare