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.
Reduce recurrence of C- Diff infection
See PA form for criteria for Medicare (Part D)
Refer to CMS local coverage determination criteria for Part B when available.
Not covered for Commercial and Medicaid