Prior authorization updates for specialty pharmacy

Medicaid

 

Effective for dates of service on and after November 1, 2021, the following specialty pharmacy codes from current or new Clinical Criteria documents will require prior authorization.

 

Please note, inclusion of a national drug code on your claim will help expedite claim processing of drugs billed with a not otherwise classified (NOC) code.

 

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

 

Clinical Criteria	HCPCS or CPT® code(s)	Drug	Generic name	Drug class
ING-CC-0179	J9037	Blenrep	Belantamab	Oncology
ING-CC-0180	J9349	Monjuvi	Tafasitamab-cxix	Oncology
ING-CC-0181	J3490	Veklury	Remdesivir	COVID-19

 

 

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your local Provider Relations representative or call Provider Services at 844-396-2330.

ANV-NU-0272-21