Medical Drug Benefit (J Code)

A prior authorization must be obtained from Magellan Rx before Medicaid medical pharmacy (J-code) services are provided by practitioners in physician offices, outpatient facilities, and home infusion centers for the prior authorized Healthcare Common Procedure Coding System (HCPCS) codes for all UPHP Medicaid lines of business. Retro active to January 1, 2020 the prior authorization process is no longer applicable for the UPHP Medicare lines of business. Requests can be made via the Magellan Rx portal or by calling 800-424-8241. Retrospective requests will not be reviewed. Magellan Rx offers peer-to-peer discussions for providers prior to any adverse determination. Utilize this process to provide information for evaluation of a request.

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Page Last Updated: 05/10/2022