Prior Authorization Drugs Updated
2/9/2012
The list of injectable medications requiring prior authorization has been updated by TriWest Healthcare Alliance. The new list is effective January 31, 2012, and is available at TriWest.com/Provider>Prior Authorization List under the Drugs and Biologicals section.
Infusion drugs must be billed using the appropriate Healthcare Common Procedure Coding System (HCPCS) code along with a specific National Drug Code (NDC) for pricing. Unlisted codes, such as J3490, should only be used if a specific HCPCS doesn’t exit. In addition, the provider should make certain that the units billed represent the units of the NDC. For pricing claims with an NDC, TriWest uses Medi-Span®.
The following drugs will be added effective January 31, 2012:
| Chemical Name | Brand Name |
| ruxolitinib |
Jakafi |
| deferiprone |
Ferriprox |
| idursulfase |
Elaprase |
| Protein C injection |
Ceprotin |
The following drug will be removed effective January 31, 2012.
