June 2019
Medicare Part B medical specialty drug prior authorization list changing
Starting in June 2019, we’re adding the following medications to the Medicare Plus BlueSM PPO and BCN AdvantageSM Part B specialty prior-authorization drug list.
Medicare Plus Blue
For dates of service on or after June 3, 2019, the following medications will require prior authorization:
- J3590 Ultomiris™
- J9999 (C9044) Libtayo®
- J3245 Ilumya™
- Q5109 Ixifi™
- J3590/J9999 Elzonris™
- J3397 Mepsevii™
- J3490 Tegsedi™
- J9173 Imfinzi®
- J3304 Zilretta®
We require prior authorization for these medications when you bill them electronically through an 837P transaction or on a professional CMS-1500 claim form for the following sites of care:
- Physician office (place of service code 11)
- Outpatient facility (place of service code 19, 22 or 24)
BCN Advantage
For dates of service on or after June 3, 2019, the following medications will require prior authorization:
- J3590 Ultomiris™
- J9999 (C9044) Libtayo®
- J3245 Ilumya™
- Q5109 Ixifi™
- J3590/J9999 Elzonris™
- J3397 Mepsevii™
- J3490 Tegsedi™
- J9173 Imfinzi®
- J3304 Zilretta®
We require prior authorization for these medications when you bill them as a professional service or an outpatient facility service electronically through an 837P transaction or on a professional CMS-1500 claim form for:
- Physician office (place of service code 11)
- Outpatient facility (place of service code 19, 22 or 24)
- Home (place of service code 12)
We also require prior authorization when you bill electronically through an 837I transaction or using a UB04 claim form for a hospital outpatient type of bill 013x.
Important reminder
You must get authorization before administering these medications. Use the NovoLogix® online tool to quickly submit your requests. It offers real-time status checks and immediate approvals for certain medications. Also note:
- For BCN Advantage, if you have access to Provider Secured Services, you already have access to enter authorization requests through NovoLogix.
- For Medicare Plus Blue, you can fax an Addendum
P form to gain access to the NovoLogix online tool.
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