Physician-administered drug changes effective September 1, 2022

Provider Icon

The Alliance has implemented physician-administered drug benefit changes. These changes have been reviewed and approved by the Pharmacy & Therapeutics (P&T) committee. The changes are as follows:

Injectable iron product updates

Preferred injectable iron products (no prior authorization required)

  • Sodium ferric gluconate (FERRLECIT).
    • J-code: J2916.
    • Max: 125mg per day.
  • Iron sucrose (VENOFER).
    • J-code: J1756.
    • Max: 400mg per day.
  • Iron dextran (INFED).
    • J-code: J1750.
    • Max: 1000mg per day.

Non-preferred injectable iron products (prior authorization required)

  • Ferric carboxymaltose (INJECTAFER).
    • J-code: J1439.
  • Ferumoxytol (FERAHEME).
    • J-code: Q0138 & Q0139.

RhoGAM updates

Rho [D] Immune Globulin (RhoGAM) (no prior authorization required)

  • J-code: J2790.
  • Max: 1 injection per day.

If you have questions, please contact the Alliance Pharmacy Department at 831-430-5507.