Effective July 15, 2021: Medical Injectable Drugs May Require Prior Authorization
Some medications covered by Johns Hopkins Advantage MD require prior authorization (or pre-authorization). This means that Advantage MD must first approve the medication before your provider can prescribe or administer it. Advantage MD verifies the medical necessity of the medication using independent, objective medical criteria. Your provider requests this approval—it is their responsibility.
Certain medical injectable drugs require prior authorization as of July 15, 2021. Medical injectable drugs are medication that you do not self-administer. These are drugs that usually are injected or infused while you are getting physician, hospital outpatient, or ambulatory surgical center services. These drugs are covered by Advantage MD under the medical benefit (Part B).
Advantage MD is committed to delivering cost-effective quality care to our members. This effort requires us to ensure that our members receive only treatment that is medically necessary, according to current standards of practice.
Frequently Asked Questions:
- How do I determine if my treatment requires prior authorization?
You may determine which specific Part B drugs require prior authorization by searching for your drug on the Advantage MD Part B Prior Authorization List.
- How do I determine if I meet the criteria for prior authorization?
You may determine the prior authorization criteria by searching for the drug on the Advantage MD Part B Prior Authorization Criteria.
- What do I do if my treatment requires prior authorization?
Your provider may submit the prior authorization directly to Advantage MD. You will be notified of the decision via phone and mail. Contact your provider to determine next steps.