Changes to Prior Authorization Review Process for Select Physician administered Drugs

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The South Carolina Department of Health and Human Services (SCDHHS) today announced the prior authorization review for several physician-administered drugs will transition from a review process administered by KEPRO to a review process administered by Magellan Specialty (formerly ICORE). This change is effective Feb. 4, 2021, for the drugs listed below. Providers should continue to use the KEPRO prior authorization review process until Feb. 4, 2021.

Code

Drug Name

Code

Drug Name

90378

Synagis

J9145

Darzalex

J0222

Onpattro

J9173

Imfinzi

J0517

Fasenra

J9205

Onivyde

J0584

Crysvita

J9395

Faslodex

J1303

Ultomiris

Q5103

Inflectra

J1322

Vimizim

Q5104

Reflexis

J2182

Nucala

Q5106

Retacrit

J2350

Ocrevus

Q5108

Fulphila

J2357

Xolair

Q5110

Nivestym

J2786

Cinqair

Q5111

Udenyca

J3398

Luxturna

Q5112

Ontruzant

J9022

Tecentriq

Q5113

Herzuma

J9023

Bavencio

Q5114

Ogivri

J9047

Kyprolis

Q5116

Trazimera

J9119

Libtayo

 

 

The prior authorization requirement will be removed for Mvasi (Q5107) and Avastin (J9035) at this time and until further notice.

Beginning Feb. 4, 2021, providers may submit prior authorization requests to Magellan Specialty using any of the following methods:

  • Providers may contact Magellan Specialty by calling (800) 424-8219
  • Providers may fax requests to Magellan Specialty’s HIPAA-compliant fax line at (888) 656-6671
  • Providers may submit requests through Magellan Specialty’s secure web portal at https://ih.magellanrx.com/

Authorization or denial for the drug will be communicated to the provider by Magellan Specialty. Failure to obtain approval prior to provision of services may result in a claim denial.

Please direct any questions or concerns regarding this bulletin to the SCDHHS Provider Service Center at (888) 289-0709. 

Thank you for your continued support of the South Carolina Medicaid Program.

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