3/21/2019
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Posted by Provider Relations
The following section of the Fidelis Care authorization grids has been updated
effective May 1, 2019.
The following services apply to the Medicaid, Child Health Plus, HARP, Essential Plans, and
Metal-Level Products (QHP) lines of business, and require prior authorization:
IX. Pharmacy:
B. This injectable code requires prior authorization:
J1442 – Neupogen
(filgrastim products including Zarxio and Nivestym do not require PA)
Visit: Authorization Grids