News
Effective 6/1: Ambetter Clinician-Administered Drug Prior Authorization Update
Date: 05/27/20
Ambetter from Superior HealthPlan requires Prior Authorization (PA) as a condition of payment for many Clinician-Administered Drugs (CADs) provided to Ambetter members. Effective June 1, 2020, the following changes to PA requirements will take effect:
HCPCS Code | Description | Prior Authorization Requirements |
|---|---|---|
Q5101 | INJ FILGRASTIM EXCL BIOSIMILAR (NEUPOGEN) | No PA required for participating providers. |
Q5108 | INJ PEGFLGRSTM-JMDB BIOSIMLR 0.5 MG (FULPHILA) | No PA required for participating providers. |
Q5111 | INJECTION, PEGFILGRASTIM-CBQV, BIOSIMILAR, 0.5 MG (UDENYCA) | No PA required for participating providers. |
Q5105 | INJECTION EPOETIN ALFA-EPBX BIOSIMILAR 100 UNITS (RETACRIT) | No PA required for participating providers. |
Q5106 | INJECTION EPOETIN ALFA-EPBX BIOSIMILAR 1000 U (RETACRIT) | No PA required for participating providers. |
Q5107 | INJECTION BEVACIZUMAB-AWWB BIOSIMILAR 10 MG (MVASI) | No PA required for participating providers. |
Q5118 | INJECTION BEVACIZUMAB-BVCR BIOSIMILAR 10 MG (ZIRABEV) | No PA required for participating providers. |
Q5114 | INJECTION TRASTUZUMAB-DKST BIOSIMILAR 10 MG (OGRIVI) | No PA required for participating providers. |
Q5116 | INJECTION TRASTUZUMAB-QYYP BIOSIMILAR 10 MG (TRAZIMERA) | No PA required for participating providers. |
Providers may submit a PA request by:
- Utilizing Superior’s Secure Provider Portal.
- If you are not currently registered on the portal, registration is quick and simple.
- Faxing an authorization to the Superior HealthPlan Pharmacy Department at 1-800-690-7030.
As a reminder, providers may determine which specific codes require PA by visiting Superior's Pre-Auth Needed Tool and selecting Ambetter.
For questions regarding this information, please contact your dedicated Account Manager or call Provider Services at 1-877-687-1196.