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Oct 1, 2019

Medical drug review

Effective December 1, 2019, BCBSRI will begin requiring prior authorization for an expanded list of specialty drugs that are covered under our medical benefit for commercial products only. Please refer to the table below. Please note, this does not apply to Medicare Advantage products at this time. Prior authorization will be handled by our pharmacy benefits manager, Prime Therapeutics, LLC.

HCPCS Code (J-CODE)
Drug
J9261
Arranon® (nelarabine)
J9032
Beleodaq® (belinostat)
J9229
Besponsa™ (inotuzumab ozogamicin)
J9039
Blincyto® (blinatumomab)
J9044
Bortezomib (bortezomib)
J9145
Doxil® (doxorubicin hydrochloride liposome)a
J9176
Empliciti™ (elotuzumab)
J9307
Folotyn® (pralatrexate)
J9179
Halaven® (eribulin mesylate)
J9325
Imlygic® (talimogene laherparepvec)
J9315
Istodax™ (romidepsin)
J9043
Jevtana™ (cabazitaxel)
J9285
Lartruvo™ (olaratumab)
J9203
Mylotarg™ (gemtuzumab ozogamicin)
J9205
Onivyde™ (irinotecan liposome)
J9295
Portrazza™ (necitumumab)
J9262
Synribo® (omacetaxine mepesuccinate)
J9999-unlisted code
Unituxin® (dinutuximab)
J9041
Velcade® (bortezomib)
J9153
Vyxeos™ (daunorubicin and cytarabine)
J9353
Yondelis® (trabectedin)
A9543
Zevalin® (ibritumomab tiuxetan)
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