Drugs moving from the specialty pharmacy benefit to the medical benefit
As of 1 de octubre de 2019, for commercial members, the drugs listed below will move from the specialty pharmacy benefit to the medical benefit. These drugs will continue to require prior authorization (PA) through Prime Therapeutics, LLC, our pharmacy benefits manager. As a reminder, there are three mechanisms for submitting a PA: CoverMyMeds (www.covermymeds.com), fax (1-855-212-8110), and mail (Prime Therapeutics LLC Attn.: Clinical Review Dept. 1305 Corporate Center Dr., Eagan, MN 55121).
As with other drugs covered under the medical benefit, the drugs below are eligible for buy and bill. When billing for any of these drugs, the appropriate HCPC codes are included in the listing; administration codes will be required, as previously utilized.