We’ve partnered with Magellan Rx Management (Magellan Rx) for medical pharmacy management, including the provider administered injectable medication and claim edit programs, to ensure our members receive quality and affordable care.
New prior authorization requirements
Effective Oct. 1, 2017, the partnership with Magellan Rx expanded to include a Site of Care program that directs members to the most cost-effective, yet clinically appropriate, location to receive their infusion(s) of the select specialty medications. (see medication list, below)
The Site of Care program applies to all fully insured Commercial members and to all EOCCO members who began using these medications on or after Oct. 1. Members who were currently using these medications were subject to the Site of Care program requirements upon prior authorization renewal on or after Oct. 1. They were notified of this change by Aug. 1, 2017.
Through the current prior authorization program administered by Magellan Rx, infusion requests for a hospital outpatient setting for the listed medications will be redirected to a preferred site of service, which will be either preferred home infusion providers or a professional office setting. Infusions for these medications will not be covered when administered in a hospital outpatient infusion center.
The medications included in the Site of Care program already require prior authorization through Magellan Rx. The Site of Care program requirements were administered as part of the existing prior authorization program. As a reminder, Moda Health will deny services as provider responsibility when prior authorization is not obtained for any medications that require prior authorization.
Questions?
We're here to help. To learn more about the Site of Care program, please email medical@modahealth.com or call us toll-free at 877-605-3229. (TTY users, please call 711.)
