The Fidelis Care Blog

Due to the FDA withdrawing approval of Makena and its generics on April 6, 2023, Fidelis will no longer be covering Makena or its generics beginning April 7, 2023, unless otherwise noted.  

The following HCPCS codes are affected:

• J1726 (Injection, hydroxyprogesterone caproate, (Makena), 10 mg) will deny as non-covered benefit beginning April 7, 2023.
• J1729 (Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg) will be excluded from coverage for preterm birth indications.  Beginning June 1, 2023, prior authorization (PA) will be required for non-pregnancy related indications.

Please see the following FDA website for further information: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/makena-hydroxyprogesterone-caproate-injection-information