Part B medications requiring prior authorization

Providers are reminded to review the Part B prior authorization medication list below on a regular basis for any updates or changes.

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). Click here for examples.
• 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.