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Medical benefit (Part B) drugs that require prior authorization

Security Health Plan requires prior authorization before you receive certain home infusion and medical benefit drugs. We have partnered with Magellan Rx to manage this process to review and approve these treatments.

Medical benefit drug prior authorization

Security Health Plan of Wisconsin, Inc., is partnering with Magellan Rx Management (Magellan Rx) to manage the process for reviewing and approving certain medical benefit drugs.

What are medical benefit drugs?

Medical benefit drugs are administered by a health care provider in the provider’s office, clinic, hospital or by home infusion. These drugs are primarily administered by:

What is the benefit to this?

Through this program with Magellan Rx, your prescriber will have access to discuss the treatment plan and current guidelines and other clinical considerations surrounding these treatments with a physician in the same specialty from Magellan Rx. This change will help us manage medical benefit drug costs and keep premiums low.

Do I need to request a prior authorization or will my doctor do that for me?

Security Health Plan covers home infusion administration, including certain drugs, supplies and nursing services from an in-network provider. If your provider is in-network they will obtain authorization on your behalf.   If your provider is not affiliated with Security Health Plan, you are responsible for initiating and ensuring authorization is on file prior to receiving services. 

To request a prior authorization for payment, have your provider contact Security Health Plan   before    the medical benefit drug is provided. With the exception of emergency or urgent care services, Security Health Plan will not pay for a medical benefit drug that has already been provided by a non-network health care provider, unless otherwise stated in your Schedule of Benefits. All of the following criteria for prior authorization must be met:

Does this mean my prescriptions won’t be covered?

There will be no change in your member benefits. You will continue to receive the same care and access to drugs that are currently available as part of your medical and pharmacy benefits. As with all services, they must be medically necessary to be considered a covered service.

Does Part B cover home infusion drugs?
Some home infusion drugs may require prior authorization.   Click here  to learn more.

How do I know if a medical benefit drug I am prescribed requires a prior authorization?
For a list of medical benefit drugs that require prior authorization, see below.

Drugs that require prior authorization

Drugs with an asterisk (*)  are managed by Magellan Rx.   You can contact Magellan Rx at 1-800-424-8243.  For all other drugs contact Security Health Plan at 1-800-472-2363. 

Brand name Generic name
Abraxane® * paclitaxel
Actemra® * tocilizumab
Acthar HP® * corticotropin
Adcetris® * brentuximab vedotin
Aimovig erenumab-aooe
Akynzeo fosnetupitant/palonosetron
Aldurazyme® * laronidase
Alimta® * pemetrexed
Aloxi® * palonosetron
Aranesp® * darbepoetin
Arzerra® * ofatumumab
Avastin® (Oncology indications only) * bevacizumab
Bavencio® * avelumab
Beleodaq® * belinostat
Bendeka® * bendamustine
Benlysta® * belimumab
Berinert® * C1 Inhibitor
Bivigam® * intravenous immune globulin
Blincyto® * blinatumomab
Botox® * onabotulinumtoxinA
Carimune NF® * intravenous immune globulin
Cerezyme® * imiglucerase
Cimzia® * certolizumab pegol
Cinqair® * reslizumab
Cinryze® * C1 Inhibitor
Crysvita burosumab-twza
Cuvitru® * immune globulin
Cyramza® * ramucirumab
Dacogen® * decitabine
Darzalex® * daratumumab
Dupixent dupilumab
Durolane® hyaluronic acid
Dysport® * abobotulinumtoxinA
Elaprase® * idursulfase
Elelyso® * taliglucerase alfa
Eligard® * leuprolide acetate (for depot suspension)
Emend® * fosaprepitant
Empliciti® * elotuzumab
Entyvio® * vedolizumab
Erbitux® * cetuximab
Euflexxa® hyaluronan or derivative
Exondys 51® * eteplirsen
Eylea® * aflibercept
Fabrazyme® * agalsidase beta
Faslodex® * fulvestrant
Feraheme ferumoyxtol
Firazyr® * icatibant
Flebogamma® * intravenous immune globulin
Fulphila® * pegefilgrastim-jmdb
Fusilev® * levoleucovorin calcium
Gammagard® Liquid * intravenous immune globulin
Gammagard® S/D * immune globulin
Gammaked® * intravenous immune globulin
Gammaplex® * intravenous immune globulin
Gamunex-C® * intravenous immune globulin
Gazyva® * obinutuzumab
Gel-One® * hyaluronan or derivative
GelSyn-3® hyaluronan or derivative
GenVisc 850 ® hyaluronan or derivative
Granix® * tbo-filgrastim
Haegarda C1 Esterase Inhibitor
Halaven® * eribulin
Herceptin® * trastuzumab
Hizentra® * subcutaneous immune globulin
Hyalgan® * hyaluronan or derivative
Hymovis® hyaluronan or derivative
HyQvia® * subcutaneous immune globulin
Imfinzi durvalumab
Inflectra® * infliximab-dyyb
Injectafer ferric carboxymaltose
Intravenous Immune globulin * intravenous immune globulin
Jevtana® * cabazitaxel
Kadcyla® * trastuzumab emtansine
Kalbitor® * ecallantide
Keytruda® * pembrolizumab
Krystexxa® * pegloticase
Kyprolis® * carfilzomib
Lemtrada® * alemtuzumab
Leukine® * sargramostim
Libtayo cemiplimab-rwlc
Lucentis * ranibizumab
Lumizyme * alglucosidase alfa
Lumoxiti moxetumomab pasudotox-tdfk
Lupron® Depot * leuprolide acetate (for depot suspension)
Lupron® Depot Ped * leuprolide acetate (for depot suspension)
Lupron® Depot/ Eligard * leuprolide acetate (for depot suspension)
Macugen * pegaptanib
Marqibo® * vincristine liposomal
Monovisc hyaluronic acid
Mozobil® * plerixafor
Myobloc * rimabotulinum toxin B
Naglazyme® * galsulfase
Neulasta® * pegfilgrastim
Neupogen® * filgrastim
NPLATE® * romiplostim
Nucala® * mepolizumab
Ocrevus® * ocrelizumab
Octagam® * intravenous immune globulin
Oncaspar * pegasparagase
Onivyde® * irinotecan liposome
Opdivo® * nivolumab
Orencia® * abatacept
Orthovisc® hyaluronan or derivative
Perjeta® * pertuzumab
Portrazza® * necitumumab
Privigen® * intravenous immune globulin
Procrit®/Epogen® * epoetin alfa
Prolia® * denosumab
Provenge® * sipuleucel-t
Radicava® edaravone
Remicade® * infliximab
Remodulin® * treprostinil
Renflexis® * infliximab-abda
Retacrit® * epoetin alfa-epbx
Rituxan® * rituximab
Ruconest® * C1 Esterase Inhibitor [recombinant]
Sandostatin® LAR * octreotide
Simponi ARIA® * golimumab
Soliris® * eculizumab
Spinraza® * nusinersen
Stelara®- IV * ustekinumab
Stelara®- SQ * ustekinumab
Supartz® hyaluronan or derivative
Sustol® * granisetron extended release
Sylvant® * siltuximab
Synagis® * pavilzumab
Synojoynt® sodium hyaluronate
Synribo® * omacetaxine
Synvisc® hyaluronan or derivative
Synvisc-One® hyaluronan or derivative
Takhzyro lanadelumab-flyo
Tecentriq® * atezolizumab
Treanda® * bendamustine
Trelstar® Depot * triptorelin Pamoate
Triferic ferric pyrophosphate
TriVisc® sodium hyaluronate
Tysabri® * natalizumab
Vantas® * histrelin acetate
Vectibix ® * panitumumab
Velcade® * bortezomib
Veletri/Flolan® * epoprostenol
Visco-3® hyaluronate sodium
Vpriv® * velaglucerase alfa
Xeomin® * incobutulinumtoxinA
Xgeva® * denosumab
Xolair® * omalizumab
Yervoy® * ipilimumab
Yondelis® * trabectedin
Zaltrap® * aflibercept
Zarxio® * filgrastim-sndz
Zoladex® * goserelin Acetate Implant