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Medicare Part B Drug Prior Authorization Policies

Brand nameJ Code
ACTEMRAJ3262
ACTHARJ0800
ADAKVEOJ0791
ADYNOVATEJ7207
AFSTYLAJ7210
AKYNZEOJ1454
ALDURAZYMEJ1931
ALOXIJ2469
ALPHANINE SD/MONONINEJ7193
ALPROLIXJ7201
ARANESP J0881
ARANESP J0882
AVEEDJ3145
AVSOLAQ5121
BENLYSTAJ0490
BEOVUJ0179
BERINERTJ0597
BIVIGAMJ1556
BOTOXJ0585
CARIMUNE NANOFILTEREDJ1566
CEREZYMEJ1786
CIMZIAJ0717
CINQAIRJ2786
CINQAIRJ0598
CINVANTIJ0185
COAGADEXJ7175
CRYSVITAJ0584
CUVITRUJ1555
DEPO-TESTOSTERONEJ1071
DUROLANEJ7318
DYSPORTJ0586
ELAPRASEJ1743
ELELYSOJ3060
ELOCTATEJ7205
EMENDJ1453
ENTYVIOJ3380
EPOGEN/PROCRITJ0885
EPOGEN/PROCRITQ4081
ESPEROCTJ7204
EUFLEXXAJ7323
EVENITYJ3111
EXONDYS 51J1428
EYLEAJ0178
FABRAZYMEJ0180
FASENRAJ0517
FERAHEMEQ0138
FERAHEMEQ0139
FERRLECITJ2916
FIBRYGAJ7177
FIRAZYRJ1744
FLEBOGAMMA DIFJ1572
FLOLANJ1325
FULPHILAQ5108
GAMASTANJ1460
GAMIFANTJ9210
GAMMAGARD LIQUIDJ1569
GAMMAPLEXJ1557
GAMUNEX-CJ1561
GEL-ONEJ7326
GELSYN-3J7328
GENVISC 850J7320
GIVLAARIJ0223
GLASSIAJ0257
GRANIXJ1447
HELIXATE FS/ADVATE/ELOCTATE/KOGENATE FS/RECOMBINATEJ7192
HEMLIBRAJ7170
HIZENTRAJ1559
HYALGANJ7321
HYMOVISJ7322
HYQVIAJ1575
IDELVIONJ7202
ILUMYAJ3245
INFLECTRAQ5103
INJECTAFERJ1439
IXINITY/BENEFIXJ7195
JIVIJ7208
KALBITORJ1290
KANUMAJ2840
KOATE/HEMOFIL AJ7190
KOVALTRYJ7211
KRYSTEXXAJ2507
LEMTRADAJ0202
LEUKINEJ2820
LUCENTISJ2778
LUMIZYMEJ0221
LUXTURNAJ3398
MACUGENJ2503
MAKENAJ1726
MEPSEVIIJ3397
MIRCERAJ0888
MIRCERAJ0887
MONOFERRICJ1437
MONOVISCJ7327
MOZOBILJ2562
MYOBLOCJ0587
NAGLAZYMEJ1458
NEULASTAJ2505
NEUPOGENJ1442
NIVESTYMQ5110
NOVOEIGHTJ7182
NPLATEJ2796
NUCALAJ2182
NUWIQJ7209
NYVEPRIAQ5122
OCREVUSJ2350
OCTAGAMJ1568
OCTREOTIDE ACETATEJ2354
ONPATTROJ0222
OpdivoJ9299
ORENCIAJ0129
ORTHOVISCJ7324
PARSABIVJ0606
PRIVIGENJ1459
PROBUPHINE IMPLANT KITJ0570
PROFILNINE/BEBULINJ7194
PROLIAJ0897
RADICAVAJ1301
REBINYNJ7203
REBLOZYLJ0896
REMICADEJ1745
REMODULINJ3285
RENFLEXISQ5104
RETACRITQ5105
RETACRITQ5106
RIASTAPJ7178
RIXUBISJ7200
RUCONESTJ0596
SANDOSTATIN LAR DEPOTJ2353
SIGNIFOR LARJ2502
SIMPONI ARIAJ1602
SOLIRISJ1300
SOMATULINE DEPOTJ1930
SPINRAZAJ2326
SPODIUM HYALURONATEJ7317
STELARAJ3358
SUBLOCADEQ9991
SUBLOCADEQ9992
SUSTOLJ1627
SYNVISC/SYNVISC ONEJ7325
TEPEZZAJ3241
TESTOPELS0189
TRILURONJ7332
TRIVISCJ7329
TYSABRIJ2323
UDENYCAQ5111
ULTOMIRISJ1303
VENOFERJ1756
VIMIZIMJ1322
VISCO-3J7333
VISUDYNEJ3396
VIVITROLJ2315
VPRIVJ3385
VYEPTIJ3032
XEMBIFYJ1558
XEOMINJ0588
XGEVAJ0897
XIAFLEXJ0775
XOLAIRJ2357
XYNTHAJ7185
ZARXIOQ5101
ZEMAIRAJ0256
ZIEXTENZOQ5120
ZOLGENSMAJ3399