Authorizations for Medical Drugs
For phase 1 drugs on or after April 28, 2021 and for phase 2 drugs on or after June 16, 2021, you can request authorizations via the following: 1. Fax to 1-888-348-7332 or 2. Submit via the CoverMyMeds portal at https://www.covermymeds.com/main/
For assistance with authorizations or questions about denials: 1. Dial the same 800-672-7897 located on the back of the member ID care for the “Prior Review/Certification” department. 2. After hearing the welcome message, press #3 “Authorizations for a Medication.” Then, select one of the following: Press #1: “Calls in response to a denial notification.” Press #2: “Calling in regards to a medication administered by the provider.” Press #3: “For all other Medication requests.” This will route the provider to pharmacy staff who can answer other questions regarding prescription drug authorizations or PBM rejection claim issues. Phase Number Effective Date* Drug** HCPCS Code** 1 4/28/2021 Actemra (tocilizumab) J3262 1 4/28/2021 Avsola (infliximab-axxq) Q5121 1 4/28/2021 Benlysta (belimumab) J0490 1 4/28/2021 Botox (onabotulinumtoxinA) J0585 1 4/28/2021 Cimzia (certolizumab pegol) J0717 1 4/28/2021 Cinqair (reslizumab) J2786 1 4/28/2021 Durolane (hyaluronic acid) J7318 1 4/28/2021 Dysport (abobotulinumtoxinA) J0586 1 4/28/2021 Entyvio (vedolizumab) J3380 1 4/28/2021 Euflexxa (hyaluronic acid) J7323 1 4/28/2021 Fasenra (benralizumab) J0517 1 4/28/2021 Gel-One (hyaluronic acid) J7326 1 4/28/2021 Gelsyn-3 (hyaluronic acid) J7328 1 4/28/2021 Genvisc 850 (hyaluronic acid) J7320 1 4/28/2021 Hyalgan, Supartz (hyaluronic acid) J7321 1 4/28/2021 Hymovis (hyaluronic acid) J7322 1 4/28/2021 Ilumya (tildrakizumab-asmn) J3245 1 4/28/2021 Inflectra (infliximab-dyyb) Q5103 1 4/28/2021 Ixifi (infliximab-qbtx) Q5109 1 4/28/2021 Monovisc (hyaluronic acid) J7327 1 4/28/2021 Myobloc (botulinum toxin type B) J0587 1 4/28/2021 Nucala (mepolizumab) J2182 1 4/28/2021 Orencia (abatacept) J0129 1 4/28/2021 Orthovisc (hyaluronic acid) J7324 1 4/28/2021 Remicade (infliximab) J1745 1 4/28/2021 Renflexis (infliximab-abda) Q5104 1 4/28/2021 Sandostatin (octreotide) J2354 1 4/28/2021 Sandostatin LAR Depot (octreotide) J2353 1 4/28/2021 Signifor LAR (pasireotide) J2502 1 4/28/2021 Simponi Aria (golimumab) J1602 1 4/28/2021 Somatuline Depot (lanreotide) J1930 1 4/28/2021 Stelara (ustekinumab) IV J3358 1 4/28/2021 Stelara (ustekinumab) SQ J3357 1 4/28/2021 Synojoynt (hyaluronic acid) J7331 1 4/28/2021 Synvisc, Synvisc-One (hyaluronic acid) J7325 1 4/28/2021 Tremfya (guselkumab) J1628 1 4/28/2021 Triluron (hyaluronic acid) J7332 1 4/28/2021 Trivisc (hyaluronic acid) J7329 1 4/28/2021 Visco-3 (hyaluronic acid) J7333 1 4/28/2021 Xeomin (incobotulinumtoxinA) J0588 1 4/28/2021 Xolair (omalizumab) J2357
*Effective Dates are subject to change.
**Drug list and HCPCS codes may not be all-inclusive and may be subject to change closer to effective dates listed. Phase Number Effective Date* Drug** HCPCS Code** 2 6/16/2021 Adakveo (crizanlizumab-tmca) J0791 2 6/16/2021 Aldurazyme (laronisdase) J1931 2 6/16/2021 Aralast NP (alpha 1 proteinase inhibitor) J0256 2 6/16/2021 Asceniv (immune globulin) C9072, J3490, J3590 2 6/16/2021 Berinert (C1 esterase inhibitor (human)) J0597 2 6/16/2021 Bivigam (immune globulin) J1556 2 6/16/2021 Brineura (cerliponase alfa) J0567 2 6/16/2021 Probuphine (buprenorphine) implant J0570 2 6/16/2021 Cerezyme (imiglucerase) J1786 2 6/16/2021 Cinryze (C1 esterase inhibitor (human)) J0598 2 6/16/2021 Crysvita (burosumab-twza) J0584 2 6/16/2021 Cutaquig (immune globulin) - SCIg C9399, J3490, J3590 2 6/16/2021 Cuvitru (immune globulin) - SCIg J1555 2 6/16/2021 Durysta (bimatoprost) implant J7351 2 6/16/2021 Elaprase (idursulfase) J1743 2 6/16/2021 Eleylyso (taliglucerase alpha) J3060 2 6/16/2021 Evenity (romosozumab-aqqg) J3111 2 6/16/2021 Exondys 51 (