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Medications Requiring Prior Authorization IU Health Pharmacy Benefits Management 950 N Meridian Street, Suite 600, Indianapolis, IN 46204 Phone: 317-963-3347 877-769-0191 Prior Auth Fax: 866-429-8920 These infusions and injections require authorization prior to administering. Medical claims billed using these J-codes will not pay without prior authorization. Brand Generic HCPCS Code Immune Suppressants Blood Formation Products Cimzia certolizumab pegol J0718 Aranesp darbepoetin alfa J0881, J0882 Enbrel etanercept J1438 Epogen Humira adalimumab J0135 epoetin alfa J0885, J0886 Procrit Orencia abatacept J0129 Leukine sargramostim J2820 Remicade infliximab J1745 Neulasta pegfilgrastim J2505 Simponi golimumab J3590, C9399 Neumega oprelvekin J2355 Immunomodulators Neupogen filgrastim J1441, J1440 Actimmune interferon gamma-1b J9216 Dermatologic Agents Alferon N interferon alfa-n3 J9215 Regranex becaplermin S0157 J1826, Q3025, Avonex Interferon beta-1a Stelara ustekinumab J3357 Q3026 Enzyme Replacement/Modifiers Betaseron Interferon beta-1b J1830 Cerezyme imiglucerase J1786 Copaxone glatiramer J1595 Hormonal Modifiers Infergen interferon alfacon-1 J9212 Eligard, J9217, J9218, Intron-A interferon alfa-2b J9214 leuprolide Lupron J9219, J1950 Kineret anakinra J3590 Genotropin Pegasys peginterferon alfa-2a J3590 Humatrope Peg-Intron peginterferon alfa-2b J3590 Norditropin J3590,Q3026, Nutropin Rebif interferon beta-1a somatropin J2941 C9399 Omnitrope Interferon alfa-2b & Saizen Rebetron J9214, J8499 Serostim ribavirin Zorbtive Synagis palivizumab 90378 Increlex mecasermin J2170 Tysabri natalizumab J2323 Sandostatin octreotide J2354 Metabolic Bone Disease Agents Sandostatin LAR octreotide J2353 Aredia pamidronate J2430 Supprelin LA histrelin J9225, J9226 Boniva injection ibandronate J1740 Synarel nafarelin J3490 Forteo teriparatide J3110 Testopel testosterone pellet J3490, S0189 Reclast zoledronic acid J3488 Trelstar LA triptorelin J3315 Prolia denosumab J0897 Zoladex goserelin J9202 Xgeva Zometa zoledronic acid J3487, J3489 Miscellaneous Botox onabotulinumtoxin a J0585 Dysport abobtulinumtoxin a J0586 Questions can be answered at Myobloc rimabotulinumtoxin b J0587 317-963-3347 or 877-769-0191 Respiratory Agents Prolastin proteinase inhibitor J0256, J0257 Zemaira Completed forms can be faxed Xolair omalizumab J2357 to 866-429-8920 Toxicologic Agents Vivitrol naltrexone J2315 Updated 2/28/2014 Updated 2/28/2014 .

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STIM1 Controls Calcineurin/Akt/Mtor/NFATC2‑Mediated Osteoclastogenesis Induced by RANKL/M‑CSF
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