Medical Injectable Drug (Part B) Authorization List
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A payer-maintained list of injectable drugs (Medicare Part B) that typically require prior authorization or step therapy before administration in outpatient/office settings; intended for providers submitting authorization requests to Aspirus Arise/Care Continuum.
No material clinical or coverage changes in this revision.
Coverage Rules and Scope
General coverage rule
Covered when administrative requirements are met.
Drugs on this list typically require prior authorization or step therapy via the medical benefit before administration.
Drugs not found on this list do not require a prior authorization through the medical benefit. The general coverage rule is that a drug is covered when administrative requirements are met; drugs included on the Medical Injectable Drug (Part B) Authorization List typically require prior authorization or step therapy approval before administration.
HCPCS / Coding List
What Providers Must Do
Prior authorization required for listed Part B injectables
Drugs listed require prior authorization or step therapy approval through the medical benefit before administration; drugs not found on this list do not require a prior authorization through the medical benefit.
Step therapy may apply — check policy first
Some drugs on the list may require step therapy approval; providers should review the injectable drug policy prior to submitting an approval request.
How to submit an authorization request
Submit an authorization request via the OnePA Portal (online ePA), fax the authorization request form to Care Continuum at 1-877-266-1871, or call Care Continuum at 1-800-818-6747.
- Online (ePA) via the OnePA Portal
- Fax to Care Continuum: 1-877-266-1871
- Call Care Continuum: 1-800-818-6747
Authorization required — failure to obtain may trigger denial
Drugs on this list require either prior authorization or step therapy approval before they can be dispensed or given; failure to submit an authorization may result in denial.
Policy Context
This document is an administrative authorization list identifying which medical injectable drugs (Medicare Part B) are subject to prior authorization or step therapy when administered in outpatient/office settings. The drugs on this list are most often given in the doctor's office and they require either prior authorization or step therapy approval before they can be dispensed or administered. Providers should review the injectable drug policy prior to submitting an approval request and follow the listed submission methods (OnePA Portal, fax, or phone).
Key Definitions
Where These Drugs Are Administered
Office-administered Part B injectables require prior authorization
These are medical benefit (Part B) injectable drugs most often given in the doctor's office; prior authorization must be obtained before administration in outpatient/office settings.
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