Magellan Rx, administered by Magellan Rx Management, reviews and approves prior authorization for select specialty drugs that fall under the medical benefit and select oncology drugs that fall under the pharmacy benefit.
In addition to providing prior authorization, Magellan will review claims for:
- Medical necessity
- Accurate claims submission that is consistent with treatment protocol
- Appropriateness of use (e.g. prescribing in accordance to FDA labeling).
Providers are required to contact Magellan Rx to obtain prior authorizations for the following lines of business:
- Medicaid (including Child Health Plus)
- Medicare Advantage
(This requirement will not apply to our self-funded line of business.)
To access a list of drugs associated with this program and applicable policies, click this link
to be redirected to the Magellan Rx website.
Contact Provider Services at (716) 631-3282 Monday through Friday from 8 a.m. to 6 p.m.
Additions to List of Drugs
On occasion, Independent Health will add to the list of medications that require pre-authorization. The following medications will now require Magellan Rx review as of July 1, 2016:
*May be covered as a Medicare Part D benefit in certain situations
Medical Prior Authorization
(Commercial, Medicaid, Medicare Part B benefits)
Pharmacy Prior Authorization
(Commercial, Medicaid, Medicare Part D benefits)
***Prior Authorization applies to Zarxio for the pharmacy benefit only. When dispensed as a medical benefit, Zarxio is subject to the post-service claim edit only; no prior authorization required when dispensed as medical benefit.