2021 Specialty Pharmacy Infusion Site Of Care Benefit Preauthorization Drug List
List of medical-benefit procedure codes (J/C/Q codes and some HCPCS) that require prior authorization for provider-administered therapy and/or infusion site of care and/or are delegated to AIM Specialty Health for medical oncology & supportive care review; includes delegation effective dates and notes about oncology-diagnosis requirement for AIM reviews. This part contains code-to-drug mappings and delegation/PA routing notes effective Oct 11, 2021 and Jan 1, 2021 references.
Many oncology drug codes were delegated to AIM Specialty Health for review effective 10/11/2021.
Medical Benefit Specialty Pharmacy prior authorization may require PA through BCBSOK effective Jan 1, 2021 for Fully Insured & ASO members.
Multiple procedure/drug administration codes were added to the 2021 list and marked 'Added to list*' or 'Added effective 01/01/2021'.
Many codes have change in 'Reason for Prior Authorization Requirement' to align with updates in Medical Policy.
J9285 (injection, olaratumab, 10 mg) discontinued and retired effective 10/01/2021.
Prior authorization delegation to AIM clarified for many Provider Administered Drug Therapy codes effective 10/11/2021.
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