Changes to our injectable medication authorization processes

As you are aware Moda has has partnered with MagellanRx to assist you in medical pharmacy management through the provider administered injectable medication program. Moda Health is committed to providing our members with access to high-quality healthcare. With this commitment in mind and to ensure quality care and affordability to our members, we will implement updates to our processes in regard to the review and approval of certain injectable medications.

Effective April 1, 2017

The MagellanRx program applies to all fully insured Commercial membership. Select ASO, Medicare Advantage, PERS Medicare and non-Medicare membership will be added at this time as well. An additional 4 new HCPCs are being added to the prior authorization list of medications.

All in-network individual, ASO, small, and large group plans, Moda will deny services if required prior authorization is not obtained prior to rendering the service. If a prior authorization is not obtained for in-network services, Moda will deny charges as provider responsibility.

What injectable medications will be covered?

MagellanRx will review your prior authorization requests for the following specialty injectable medications that are performed in:

Effective April 1, 2017
Procedure code Brand name
J9325 Imlygic
J9999 Lartuvo
J2507 Krystexxa
J9202 Yondelis

Injectable Medical Prior Authorization List (last updated 2/2017)

Working together to improve patient care

Making sure our members receive the best possible care at the most affordable price is why we come to work each day. But we can’t do this alone. We appreciate your support in assuring Moda Health members receive high quality, affordable care and deliver results consistent with nationally recognized clinical criteria and guidelines.

To learn more about our injectable medication program, please take a look at our FAQ (last updated 2/2017) or call our Customer Service team toll-free at 800-258-2037.

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