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2019 Prior Authorization for Medicare Part B Drugs (Non-Oncology )


Providers: For the quickest turnaround on prior authorizations, use Availity. You can find the login link and instructions in the "Using Availity" section of our Providers page.

Members: Usually, your provider handles prior authorization requests for you, but you can ask for one yourself. Learn how to ask for a prior authorization.

The drugs listed below require prior authorization. We give the generic name first, followed by the brand name in italics, so it's Generic Name (Brand Name).

A

Aflibercept (Eylea)

C

C-1 esterase inhibitor, human (Berinert)

C-1 esterase inhibitor, human (Cinryze)

Certolizumab pegol (Cimzia)

D

Darbepoetin alfa for ESRD (Aranesp for ESRD)

E

Eculizumab (Soliris)

Epoprostenol sodium (Flolan, Veletri)

Etanercept (Enbrel)

G

Golimumab (Simponi Aria)

H

Hemin (Panhematin)

Hyaluronate sodium (Orthovisc)

Hyaluronate sodium, stabilized (Monovisc)

Hylan G-F 20 (Synvisc, Synvisc-One)

I

Iloprost tromethamine (Ventavis)

Immune Glublin SC (Hizentra)

Infliximab (Remicade)

Interferon beta-1a, IM (Avonex)

Interferon beta-1a, SC (Avonex)

N

Natalizumab (Tysabri)

O

Octreotide acetate depot (Sandostatin LAR Depot)

Omalizumab (Xolair)

Onabotulinum toxin A (Botox)

P

Pegloticase (Krystexxa)

R

Ranibizumab (Lucentis)

T

Tocilizumab (Actemra)

Treprostinil (Tyvaso)

Treprostinil sodium (Remodulin)

U

Ustekinumab (Stelara)