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November 2014

Chrysler groups to participate in prior authorization program

Beginning Jan. 1, 2015, all Chrysler group segments will participate in the Medical Drug Prior Authorization Program.

Keep in mind that the prior authorization requirement does not apply to Medicare, Medicare Advantage or Federal Employee Program® members.

The list below reflects all the medications that are part of the Medical Drug Prior Authorization Program.

Actemra®
Acthar® gel
Adagen®
Aldurazyme®
Benlysta®
Berinert®
Bivigam™
Botox®
Carimune® NF
Cerezyme®
Cinryze®
Dysport®
Elaprase®

Elelyso™
Entyvio™
Fabrazyme®
Febogamma® DIF
Firazyr®
Gammagard Liquid
Gammagard® S/D
Gammaked®
Gammaplex®
Gamunex®
Hizentra®
Ig, IV injection NOS
Ilaris®

Kalbitor®
Krystexxa®
Lumizyme®
Makena®
Myobloc®
Myozyme®
Naglazyme®
Nplate®
Octagam®
Orencia®
Privigen®
Prolia®

Simponi® Aria™
Soliris®
Stelara®
Synagis®
Tysabri®
Vimizim™
Vpriv®
Xeomin®
Xgeva®
Xiaflex®
Xolair®

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2013 American Medical Association. All rights reserved.
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