Medicare Advantage Members
Part B Drugs
Part B Medications Requiring Prior Authorization
Monthly updates may be added to the Prior Authorization List. Providers are reminded to review the Prior Authorization list on a regular basis for any updates or changes which may be added.
Please contact Customer Service with specific code information to determine if an item or service requires prior authorization.
Prior authorization is required for the clinic-administered medications listed below. Practitioners must submit a prior authorization request via My Quartz Tools or fax us a Clinic-Administered Medication PA Form.
- View the Part B Prior Authorization Medication List
- View the applicable Part B Prior Authorization Criteria
- View the Part B Step Therapy Criteria
Medicare Drug Coverage Policies apply (Local Coverage Determinations (LCD), National Coverage Determinations (NCD), etc), but do not require prior authorization. Click here for examples
(for the most up-to-date Medicare policies and coverage, search the Medicare Coverage Database)
Medications that are usually self-administered are excluded from coverage under Medicare Part B
(Per the Self-Administered Drug Exclusion List (A53022))