Medical Injectable Drug Authorization List
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List of medical injectable drugs typically administered in provider offices that require prior authorization or step therapy under the medical benefit for Aspirus Arise members; applies to providers submitting authorization requests for drugs on this list.
No material clinical or coverage changes in this revision.
Coverage Criteria
This list identifies medical injectable and infusion drugs that typically require prior authorization or step therapy under the medical benefit for Aspirus Arise members. It is an administrative authorization list of items billed by HCPCS code; drugs not found on this list do not require authorization through the medical benefit. The list is subject to change — providers should check the applicable medical drug policy and effective date when preparing an authorization request.
Listed HCPCS Codes
Provider Actions & Requirements
Prior authorization required
Prior authorization or step therapy approval is required for the medical injectable drugs listed (identified by HCPCS codes) before they can be dispensed or given under the medical benefit.
Step therapy notice
Some drugs on this list may require step therapy approval; providers must review the applicable medical drug policy and its effective date before submitting an authorization request.
How to submit authorization
Submit authorization requests via the OnePA Portal (online ePA), fax the authorization request form to Care Continuum at 1-866-540-8935, or call Care Continuum at 1-866-540-8289.
- Online (ePA) via the OnePA Portal
- Fax: 1-866-540-8935 (authorization request form available on the Pharmacy webpage)
- Phone: Care Continuum at 1-866-540-8289
Denial risk if not authorized
Failure to obtain prior authorization or step therapy approval for drugs on this list may result in denial of coverage under the medical benefit.
Typical Site of Care
Site of care — office administration
Drugs on this list are typically administered in the provider's office.
Background
This document is an administrative authorization list describing injectable and infusion drugs commonly requiring medical-benefit prior authorization or step therapy. It does not contain clinical coverage criteria, dosing, indications, or contraindications — providers must refer to the corresponding medical drug policy for those clinical details. The listed drugs are generally administered in the provider's office, and prior authorization or step therapy approval is required before they can be dispensed or administered under the medical benefit.
Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.