Prior authorization requirements for Darzalex (daratumumab) drug
Effective September 1, 2018, Anthem Blue Cross and Blue Shield Medicaid prior authorization (PA) requirements will change for the injectable drug Darzalex (daratumumab) for Medicaid members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines (including definitions and specific contract provisions/exclusions) take precedence over these PA rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.
PA requirements will be added to:
J9145— Injection, Darzalex (daratumumab), 10 mg
To request PA, you may use one of the following methods:
Not all PA requirements are listed here. Detailed PA requirements are available to contracted providers by accessing the provider self-service tool (https://www.availity.com). Contracted and non-contracted providers who are unable to access Availity may call us at 1-855-661-2028 for PA requirements.
October 2018 Anthem Kentucky Provider Newsletter