Prior Authorization Drugs Updated
8/8/2012
The list of injectable medications requiring prior authorization has been updated by TriWest Healthcare Alliance. The new list is effective August 1, 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 August 1, 2012:
| Chemical Name | Brand Name |
| eculizumab |
Soliris |
The following drugs will be removed effective August 1, 2012:
| Chemical Name | Brand Name |
| ofatumumab |
Arzerra |
| irinotecan |
Camptosar |
| cetuximab |
Erbitux |
| pralatrexate |
Folotyn |
| gemcitabine |
Gemzar |
| vinorelbine |
Navelbine |