Effective August 1, 2018, Empire BlueCross BlueShield HealthPlus prior authorization (PA) requirements will change for the injectable drug Darzalex (daratumumab) for Medicaid members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines (including definitions and specific contract provisions/exclusions) take precedence over these PA rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

 

PA requirements will be added to:

  • J9145 — Injection, Darzalex (daratumumab), 10 mg

 

To request PA, you may use one of the following methods:

  • Web: https://www.availity.com
  • Fax: 1-800-964-3627
  • Phone: 1-800-450-8753

 

Not all PA requirements are listed here. Detailed PA requirements are available to contracted providers by accessing the provider self-service tool (https://www.availity.com). Contracted and noncontracted providers who are unable to access Availity may call us at 1-800-450-8753 for PA requirements.



Featured In:
June 2018 Empire Provider Newsletter