Printer Friendly

Prior Authorization & Medication Quantity Limits

dotted line

Medicare

  • Using Medicare-defined rules and guidance, Regence reviews the following medications prior to Medicare coverage:
    • Abatacept (Orencia®)
    • Aflibercept (Eylea™) -- Effective 2/1/2012
    • Alefacept (Amevive®)
    • Asparaginase erwinia chrysanthemi (Erwinaze™) -- Effective 2/1/2012
    • Belimumab (Benlysta®)
    • Bevacizumab (Avastin®) [cancer indications only; ophthalmic uses covered without review]
    • Bortezomib (Velcade®)
    • Botulinum toxin
    • Cabazitaxel (Jevtana®)
    • Cetuximab (Erbitux®)
    • Denosumab (Prolia®)
    • Denosumab (Xgeva®)
    • Doxorubicin Liposome (Doxil®) -- Effective 7/1/2011
    • Eribulin (Halaven®)
    • Hyaluronic Acid (Euflexxa®, Hyalgan®, Orthovisc®, Supartz®, Synvisc®, Synvisc-One®) -- Effective 7/14/2011
    • Hydroxyprogesterone (Makena™)
    • Ibandronate (Boniva IV®)
    • Imiglucerase (Cerezyme®)
    • Immune globulin
    • Infliximab (Remicade®)
    • Ipilimumab (Yervoy™)
    • Natalizumab (Tysabri®)
    • Ofatumumab (Arzerra™)
    • Omalizumab (Xolair®)
    • Oxaliplatin (Eloxatin®) -- Effective 7/1/2011
    • Palivizumab (Synagis®)
    • Pegaptanib (Macugen®) -- Effective 7/1/2011
    • Pegloticase (Krystexxa®)
    • Pemetrexed (Alimta®)
    • Pralatrexate (Folotyn®)
    • Ranibizumab (Lucentis®) -- Effective 7/1/2011
    • Rituximab (Rituxan®)
    • Romidepsin (Istodax®)
    • Romiplostim (Nplate®)
    • Sipuleucel-T (Provenge®)
    • Zoledronic Acid (Reclast®)
    • Zoledronic Acid (Zometa®) -- Effective 4/1/2011