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2019 Prior Authorization for Medicare Part B Drugs (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

Ado-trastuzumab emtansine (Kadcyla)

Aldesleukin (Proleukin)

Amifostine (Ethyol)

Antithymocyte globulin (Atgam)

Aprepitant injection (Cinvanti)

Aprepitant oral (Emend)

Arsenic trioxide injection (Trisenox)

Atezolizumab (Tecentriq)

Avelumab (Bavencio)

Azacitidine (Vidaza)

B

Bacillus Calmette-Guerin Live (BCG) intravesical (Tice BCG Live)

Belinostat (Beleodaq)

Bendamustine HCl injection (Treanda)

Bendamustine rapid-infusion injection (Bendeka)

Bevacizumab (Avastin)

Bevacizumab-awwb (Mvasi)

Bleomycin sulfate (Blenoxane)

Blinatumomab (Blincyto)

Bortezomib (Velcade)

Brentuximab (Adcetris)

Busulfan injection (Busulfex)

C

Cabazitaxel (Jevtana)

Calcitonin (salmon) injection (Miacalcin)

Carboplatin (Paraplatin)

Carfilzomib (Kyprolis)

Carmustine (BiCNU)

Cetuximab (Erbitux)

Cisplatin (Plaintol)

Cladribine (Leustatin)

Clofarabine (Clolar)

Copanlisib (Aliqopa)

Cyclophosphamide (Cytoxan)

Cytarabine (Cytosar-U)

Cytarabine liposomal (Depocyt)

D

Dacarbazine 100 mg (DTIC-Dome)

Dactinomycin (Cosmegen)

Daratumumab (Darzalex)

Darbepoetin alfa for non-ESRD use (Aranesp)

Daunorubicin

Daunorubicin liposomal and cytarabine liposomal (Vyxeos)

Decitabine (Dacogen)

Degarelix (Firmagon)

Denosumab (Prolia, Xgeva)

Dexrazoxane HCl (Zinecard)

Docetaxel (Taxotere)

Dolasetron mesylate (Anzemet)

Doxorubicin HCl (Adriamycin)

Doxorubicin liposomal (Doxil)

Doxorubicin liposomal (Lipodox)

Droperidol (Inapsine)

Durvalumab (Imfinzi)

E

Elotuzumab (Empliciti)

Epirubicin (Ellence)

Epoetin alfa for non-ESRD use (Procrit, Epogen)

Epoetin alfa-epbx for non-ESRD use (Retacrit)

Epoetin beta for non-ESRD use (Mircera)

Eribulin mesylate (Halaven)

Erwinaze (Erwinaze)

Etoposide (Vepesid)

F

Ferric carboxymaltose (Injectafer)

Ferumoxytol for non-ESRD use (Feraheme)

Filgrastim G-CSF (Neupogen)

Filgrastim-aafi (Nivestym)

Filgrastim-sndz (Zarxio)

Flebogamma (Flebogamma)

Floxuridine (FUDR)

Fludarabine phosphate (Fludara)

Fluorouracil (Adrucil)

Fosaprepitant (Emend)

Fostamatinib (Tavalisse)

Fulvestrant (Faslodex)

G

Gemcitabine HCl (Gemzar)

Gemtuzumab ozogamicin (Mylotarg)

Goserelin acetate implant (Zoladex)

Granisetron HCl (Kytril)

Granisetron HCl extended release (Sustol)

H

Haloperidol (Haldol)

Histrelin acetate implant (Vantas)

I

Idarubicin HCl (Idamycin)

Ifosfamide (Ifex)

Immune globulin and hyaluronidase, recombinant (Hyqvia)

Immune globulin IM (Gamastan, Gamastan S/D)

Immune globulin IV (Bivigam)

Immune globulin IV (Gammagard)

Immune globulin IV (Gammaplex)

Immune globulin IV (Gamunex-C, Gammaked)

Immune globulin IV (Octagam)

Immune globulin IV (Privigen)

Immune globulin lyophilisate IV (Carimune NF)

Immune globulin non-lyophilized IV, NOS (Immune Globulin)

Immune globulin SC (Cuvitru)

Inotuzumab ozogamicin (Besponsa)

Interferon alfa-2b recombinant (Intron-A)

Interferon gamma-1b (Actimmune)

Ipilimumab (Yervoy)

Irinotecan (Camptosar)

Irinotecan liposomal (Onivyde)

Iron dextran (INFeD)

Iron sucrose (Venofer)

Ixabepilone (Ixempra)

L

Lanreotide (Somatuline Depot)

Leucovorin calcium

Leuprolide acetate (Eligard)

Leuprolide acetate implant (Viadur)

Leuprolide acetate lyophilisate, 3.75 mg (Lupron Depot)

Leuprolide acetate lyophilisate, 7.5 mg (Lupron Depot)

Levoleucovorin calcium (Fulsilev)

Lutetium Lu 177 dotatate (Lutathera)

M

Medroxyprogesterone acetate (Depo-Provera)

Melphalan captisol-enabled (Evomela)

Melphalan HCl (Alkeran)

Methoxsalen (Uvadex)

Methylnaltrexone (Relistor)

Metoclopramide HCl (Reglan)

Mitomycin 5 mg (Mutamycin)

Mitoxantrone HCl (Novantrone)

N

Necitumumab (Portrazza)

Nelarabine (Arranon)

Netupitant/Palonosetron (Akynzeo)

Nivolumab (Opdivo)

O

Obinutuzumab (Gazyva)

Octreotide acetate (Sandostatin)

Octreotide acetate depot (Sandostatin LAR Depot)

Ofatumumab injection (Arzerra)

Olaratumab (Lartruvo)

Omacetaxine (Synribo)

Ondansetron HCl (Zofran)

Oxaliplatin (Eloxatin)

P

Paclitaxel injection (Taxol)

Paclitaxel protein-bound particles (Abraxane)

Palifermin injection (Kepivance)

Palonosetron HCl (Aloxi)

Pamidronate disodium (Aredia)

Panitumumab (Vectibix)

Pegaspargase (Oncaspar)

Pegfilgrastim (Neulasta)

Pegfilgrastim-jmdb (Fulphila)

Peginterferon alfa-2a (Pegasys)

Peginterferon alfa-2b (Pegintron, Sylatron)

Pembrolizumab (Keytruda)

Pemetrexed (Alimta)

Pentostatin (Nipent)

Pertuzumab (Perjeta)

Phytonadione (Mephyton)

Plerixafor (Mozobil)

Porfimer sodium (Photofrin)

Pralatrexate (Folotyn)

Prochlorperazine (Compazine)

Promethazine HCl (Phenergan)

R

Ramucirumab (Cyramza)

Rasburicase (Elitek)

Rho(D) immune globulin (WinRho SDF)

Rituximab (Rituxan)

Rituximab and hyaluronidase human (Rituxan Hycela)

Rolapitant injection (Varubi)

Rolapitant oral (Varubi)

Romidepsin (Istodax)

Romiplostim (Nplate)

S

Sargramostim (Leukine)

Siltuximab (Sylvant)

Sipuleucel-T (Provenge)

Streptozocin (Zanosar)

T

Talimogene laherparepvec (Imlygic)

Tbo-filgrastim (Granix)

Temozolomide (Temodar)

Temsirolimus (Torisel)

Teniposide 50 mg (Vumon)

Testosterone cypionate (Depo-Testosterone)

Testosterone enanthate (Delatestryl)

Testosterone pellet (Testopel)

Testosterone undecanoate (Aveed)

Thiotepa (Tepadina)

Thyrotropin (Thyrogen)

Topotecan (Hycamtin)

Trabectedin (Yondelis)

Trastuzumab (Herceptin)

Trastuzumab-dkst (Ogivri)

Triptorelin pamoate (Trelstar)

V

Valrubicin intravesical (Valstar)

Vinblastine sulfate (Velban)

Vincristine liposomal (Marqibo)

Vincristine sulfate (Oncovin)

Vinorelbine tartrate (Navelbine)

Z

Ziv-aflibercept (Zaltrap)

Zoledronic acid (Reclast, Zometa)