Spevigo and Xenpozyme Medical Prior Authorization Update

Effective for dates of service on and after September 1, 2023, the following medication codes billed on medical claims will require prior authorization in accordance with the requirements of the current or new Clinical Criteria documents.

Please note, inclusion of a national drug code on your medical claim is necessary for claims processing.

Visit the Clinical Criteria website to search for the specific Clinical Criteria listed below.

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your local Provider Relationship Management representative or call Provider Services at 855-661-2028.

Note: Prior authorization requests for certain medications may require additional documentation to determine medical necessity.