Macular Degeneration Eye Injections
Security Health Plans Medicare Advantage Plans, including DSNP/Ally & Secure Saver/MSA, provides coverage for Part B drugs administered in an office or outpatient setting. Benefits may differ based on member’s eligibility. Please verify member specific eligibility and benefits using the online Provider Portal. The below information are examples of what can be found using the Provider Portal:
- Member eligibility & termination dates
- Group Numbers
- Type of policy (HMO, POS, Indemnity, etc)
- COB information
- Out of Pocket Amounts (Deductible, Coinsurance, Copay)
- Prior authorization submission and status
You can check if you are a contracted provider by using our Provider Directory at https://www.securityhealth.org/#provider. Most of Security Health Plan Medicare Advantage plans allow for members to use a non-contracted provider, but may be at a higher out-of-pocket cost to the member.
Providers are required to buy the Part B drugs and bill Security Health Plan on a medical claim.
Security Health Plan’s Medicare Advantage Plans renew on a calendar year.
- Are not COBRA plans
- Are fully funded
- Do not have pre-existing conditions
Security Health Plan’s Medicare Advantage Plans do not have lifetime maximums or annual benefit caps on Part B drugs administered in the office or in an outpatient setting.
Coverage of Part B drugs and office visits varies based on the member’s policy. Please log in to the Security Health Plan Provider Portal to view member specific information such as deductible, coinsurance, copays, and out of pocket. You can also view how much has been applied to deductible and out of pocket costs using the Provider Portal.
- If a primary or specialty care office visit is billed, members may have an office visit copay, depending on plan benefits.
- Administration fees for Part B drugs do not apply any member cost-share when billed by a contracted provider
Prior Authorization Specifics
Per Security Health Plan policy, we do not require a doctor’s referral for Part B drugs, however, prior authorization may be required.
Please check the Security Health Plan Authorization page, https://www.securityhealth.org/rxpa, to see if the Part B drug you are administering requires prior authorization.
Effective for dates of service on or after May 1, 2019, Security Health Plan will implement step therapy requirements for ‘NEW’ starts of the following drugs:
- aflibercept (Eylea®), ranibizumab (Lucentis®) and pegaptanib (Macugen®) - with bevacizumab as the preferred drug
- epoetin alfa (Epogen®, Procrit®) - with epoetin alfa-epbx (Retacrit®) as the preferred drug.
Implementation for ‘new’ starts means that no members currently receiving eligible step therapy drugs under part B will have to change their drug. Step therapy prior authorization will be managed through Security Health Plan’s specialty pharmacy medication partner, Magellan. Call 1-800-424-8243; website spcustomer.magellanprovider.com.