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Medicare Part B Drugs

Clinic-Administered 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.

Medicare Drug Coverage Policies apply (but do not require prior authorization):
(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))

Questions

If you have any questions about the prior authorization list or want to know if a service or supply requires prior authorization, please contact Customer Service through the message center within My Quartz Tools for providers or MyChart for members or call (800) 394-5566.