The Alliance has implemented physician administered drug benefit changes. These changes have been reviewed and approved by the Pharmacy & Therapeutics (P&T) Committee. Find prior authorization criteria on our webpage.
The changes are as follows:
| HCPCS Code | Drug | Change |
| J1449
J9361 |
Eflapegrastim-xnst (Rolvedon)
Efbemalenograstim (Ryzneuta) |
Modified prior authorization criteria
(Neulasta is preferred) |
| J0178 | Eylea (aflibercept) | Modified PA Criteria |
| C9161 | Eylea HD (aflibercept) | Modified PA Criteria |
| Q5128 | Cimerli (ranibizumab-eqrn) | Modified PA Criteria |
| Q5124 | Byooviz (ranibizumab-nuna) | Modified PA Criteria |
| J2779 | Susvimo (ranibizumab – implant) | Modified PA Criteria |
| J0179 | Beovu (brolucizumab-dbll) | Modified PA Criteria |
| J2777 | Vabysmo (faricimab-svoa) | Modified PA Criteria |
The Alliance has updated the following pharmacy policies. To request a copy, please contact the Alliance Pharmacy Department at 831-430-5507.
· 403-1101 Pharmacy Operations Management.
· 403-1144 Pharmacy Provision of Family Planning Services.
· 403-1150 Pharmacist Services.
· 404-1731 Medication Assisted Treatment.
