Medicare Part B
Restrictions on Certain Medications Administered in the Doctor's office
Care Improvement Plus requires that providers get prior authorization for certain drugs that are usually billed under Medicare Part B. This means providers will need to get approval for certain medications before administering them in the office.
Authorization is based on a determination that services are medically necessary but is not a guarantee of payment. Payment for services is subject to member eligibility and benefit(s) limitations.
If providers don't get approval, Care Improvement Plus may not cover the drug and the provider may not be reimbursed. To receive prior authorization, please call
1-866-904-6561.
The following medications will need to go through the Prior Authorization process in 2012.
| IVIG products (Immune Globulin) |
Ventavis (Iloprost Inhalation Solution) |
| Botox (Botulinum Toxin A) |
Flolan (Epoprostenol) |
| Rituxan (Rituximab) |
Tyvaso (Treprostinil) Inhalation Solution |
| Remicade (Infliximab) |
Zemaira (Alpha-proteinase inhibitor) |
| Intron A (Interferon Alfa-2b) |
Veletri (Epoprostenol) |
| Remodulin (Treprostinil) |
Provenge (Sipuleucel-T) |
This page was last updated on: 8/17/2011 3:47:34 PM