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.
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.