This page contains information for medical pharmacy drugs that require prior authorization (PA) and/or are allowed to be administered in the home setting.
The free text ‘Search’ field allows you to search by a drug code, a drug’s generic name or a drug’s brand name. If this search field is used only the specific drugs that match the criteria entered will populate.
The category drop down allows you to select categories of drugs rather than search for a single drug. NOTE: A drug may be eligible for multiple categories and will display in each category it qualifies for.
If there is a PA indicator associated with the drug this designates a PA is required regardless of site of service.
Enter a Search term and/or a Category selection.
Home Infusion – all drugs that are allowed to be administered in the home setting for the following product lines: Commercial, SAS-Marshfield Clinic Health System Employer group only, Medicare Advantage Core/Southern, Medicare Advantage Eastern and Medicare Advantage Ally Rx (D-SNP)
Magellan Rx Prior Authorizations – all drugs that require prior authorization through Magellan Rx. If this is present with a Home Infusion eligible drug it means that the drug is allowable in the Home Infusion setting but also requires PA.
Magellan Post Service Claim Edits – all drugs that are subject to Magellan Rx’s post-service claim edits.
Security Health Plan Prior Authorizations – all drugs that require prior authorization through Security Health Plan.
Security Health Plan Post Service Claim Edits – all drugs that are subject to Security Health Plan’s post-service claim edits.