Magellan Rx, administered by Magellan Rx Management, reviews and approves prior authorization for select specialty drugs that fall under the medical 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, please
Contact Provider Services at (716) 631-3282 Monday through Friday from 8 a.m. to 6 p.m.