Medicare Advantage clinic-administered (Part B) drugs
Part B medications requiring prior authorization
Prior authorization is required for the clinic-administered medications listed in the Part B prior authorization medication list below. You’ll also find the Part B Step Therapy and Part B Prior Authorization Criteria for your review. Monthly updates may occur to the prior authorization list, so it is important to regularly review the Part B prior authorization medication list below for any updates or changes.
- Part B Prior Authorization Medication List
- Part B Step Therapy Criteria
- Part B Prior Authorization Criteria (by clicking this link you will be leaving the Quartz Medicare Advantage website)
- Follow the directions to log in to the portal
- Expand the Ambulatory Care and Behavioral Health Care menus
- Search by pressing Ctrl + F for the criteria ID or title (as noted in the Part B Prior Authorization Medication List)
Important reminders
- Practitioners must submit a prior authorization request via My Quartz Tools or fax us a Clinic-Administered Medication Prior Authorization Request Form.
- Medicare Drug Coverage Policies apply (Local Coverage Determinations (LCD), National Coverage Determinations (NCD), etc.), but do not require prior authorization (unless included in the Part B prior authorization medication list above).
- For the most up-to-date Medicare policies and coverage, search the Medicare Coverage Database (by clicking this link you will be leaving the Quartz Medicare Advantage website).
- Medications that are usually self-administered are excluded from coverage under Medicare Part B
(Per the Self-Administered Drug Exclusion List [A53022]).
Questions?
Please contact Customer Success with specific code information if you need help determining if an item or service requires prior authorization.
Contact us
Quartz is here to help. That’s why we make it easy to reach us.
Call Quartz Customer Success (844) 644-3455 or message us on Quartz MyChart.