CurrentFlorida BluePolicy N/A

Prior Authorization Program Information and Authorization Forms

Lists numerous drug products with routing (CoverMyMeds vs Availity) and preferred-agent notes (biosimilars, insulin products that do not require PA).

Policy Summary

PayerFlorida Blue

PolicyPrior Authorization Program Information and Authorization Forms

Policy CodePolicy N/A

Change TypeAdministrative/drug-list update (informational)

Effective Date

Next Review Date

Key ActionSubmit prior authorization requests via the channel indicated for each drug (CoverMyMeds or Availity) or follow routing notes such as 'For Non-Fertility related diagnoses - SEND to Availity'.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes noted; this section is an administrative listing of drugs with routing and preference notes.

150+Drugs listed in this part

11Insulin products listed as preferred (no PA)

3Preferred growth-hormone agents

2ESA preferred examples

2Primary submission channels

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Policy fragment summary

This administrative fragment lists numerous drugs and maps each to the electronic prior-authorization submission platform to be used (primarily CoverMyMeds or Availity), and highlights preferred biosimilars and insulin products that do not require prior authorization. It conveys examples of preferred substitutions (e.g., Procrit/Retacrit preferred over Aranesp/Epogen; Nivestym/Zarxio preferred over Neupogen/Granix; Norditropin, Genotropin, Omnitrope preferred within growth-hormone class), and names insulin agents that are preferred and do not require prior authorization (examples include Fiasp, Humalog, Humalog Mix, Humulin 70/30, Humulin N, Humulin R, Lyumjev, Novolin 70/30, Novolin N, Novolin R, Novolog, Novolog 70/30). The operational purpose is administrative routing (directing providers which portal to use for PA requests) and to provide formulary preferred-agent guidance. Current policy status is CURRENT and providers are instructed to use the designated channel per drug (CoverMyMeds or Availity) per the listing.

Summary

Drugs listed in this part150+

Primary submission channels2

Insulin products listed as preferred (no PA required)11

Class preferred-agent examplesNorditropin / Genotropin / Omnitrope; Procrit / Retacrit; Nivestym / Zarxio

Operational instructionRoute prior authorizations to the portal indicated per drug (CoverMyMeds or Availity).

Drug lists, preferred agents, and portal routing

Preferred agents / routing notes (drug-level)NDC

KALYDECO
KANJINTI
KEVZARA
KEYTRUDA QLEX
KHAPZORY
KHINDIVI
KINERET
KISQALI
KLISYRI
KOATE

1–10 of 255

1/26

What providers must do

Prior Authorization

Use specified submission channel

Submit prior authorization requests via the channel indicated for each drug (CoverMyMeds or Availity) or follow routing notes such as 'For Non-Fertility related diagnoses - SEND to Availity'.

Follow per-drug portal indicated (CoverMyMeds or Availity)

Documentation Required

Send prior authorization via Availity for non-fertility diagnoses

For many listed drugs (notably non-fertility related diagnoses and several named products) the instruction is to send prior authorization requests to Availity; providers should route PA accordingly.

Examples: MENOPUR (For Non-Fertility related diagnoses - SEND to Availity), PREGNYL W/DILUENT BENZYL ALCOHOL/NACL (For Non-Fertility related diagnoses - SEND to Availity), NOURIANZ (For Non-Fertility related diagnoses - SEND to Availity)

Definitions

Definitions / Key Terms

CoverMyMedsAn electronic prior authorization submission platform referenced throughout the drug listing.

AvailityAn electronic portal referenced as the routing destination for many provider-administered or buy-and-bill prior authorization requests.

CoverMyMeds / Availity (consolidated)When both platforms are mentioned, follow the drug-specific routing note; some products explicitly require sending PAs to Availity for provider-administered drugs or for non‑fertility diagnoses.

Preferred-agent guidanceEntries note preferred alternatives (e.g., Procrit/Retacrit over Aranesp/Epogen; Nivestym/Zarxio over Neupogen/Granix; Norditropin/Genotropin/Omnitrope in growth‑hormone class).

This fragment is strictly an administrative routing and reference list that indicates the submission channel for prior authorization requests and notes preferred agents; it does not provide clinical coverage criteria or decision trees. There are no criteria_trees included in this segment; clinical necessity and coverage determinations are handled by the program’s medical-necessity criteria referenced elsewhere.

Document changes

Policy Summary

PayerFlorida Blue

PolicyPrior Authorization Program Information and Authorization Forms

Policy CodePolicy N/A

Change TypeAdministrative/drug-list update (informational)

Effective Date

Next Review Date

SourceLink

On This Page

Documentation Required

Use CoverMyMeds when indicated

Many drugs reference CoverMyMeds as the platform for prior authorization submissions; providers should use CoverMyMeds where specified.

Many listed drugs reference CoverMyMeds for ePA
Examples: GAVRETO, GAZYVA, GEFITINIB (from code_groups[2]); OMNITROPE, HYRNUO (from code_groups[5])

Documentation Required

Follow preferred-agent guidance where indicated

When entries indicate preferred alternatives (e.g., Procrit/Retacrit preferred over Aranesp/Epogen; Nivestym/Zarxio preferred over Neupogen/Granix; Norditropin/Genotropin/Omnitrope preferred in class), providers should consider preferred agents per formulary guidance.

Procrit and Retacrit preferred over Aranesp and Epogen (example notes present)
Nivestym and Zarxio preferred over Neupogen and Granix (noted repeatedly)
Norditropin, Genotropin and Omnitrope preferred in the growth-hormone class

Prior Authorization

Use designated portals for PA submissions

Submit prior authorization requests via the indicated portal per drug (CoverMyMeds or Availity) as listed; some products have explicit preferred alternatives noted.

Submission must follow the portal listed for each drug (CoverMyMeds or Availity)
Some entries specify starter packs or special kits (e.g., PALFORZIA starter kits, PLEGRIDY starter pack, HEPZATO Kit)

Documentation Required

Follow preference guidance where indicated

When preference notes are present (e.g., Humira Abbvie NDCs beginning with 00074, Hadlima; Nivestym and Zarxio preferred over Neupogen and Granix; Procrit and Retacrit preferred over Aranesp and Epogen; Norditropin/Genotropin/Omnitrope preferred for ZOMACTON class), document chosen product rationale.

Document rationale when selecting a non-preferred product
Example: Humira (Abbvie NDCs beginning with 00074) and Hadlima are noted as preferred in multiple entries