Medicaid anti-emetic prior authorization update

Don’t miss these prior authorization codes

Effective Aug. 1, 2021, prior authorization is required for 8 anti-emetics codes for members with a cancer diagnosis. (Prior authorization requirements for outpatient injectable chemotherapy are not affected by this addition.)

This requirement is for members in UnitedHealthcare Community Plans in Arizona, Kentucky and Tennessee that require prior authorization for outpatient injectable chemotherapy.

Preferred products

Preferred products are Emend®, Kytril® and Zofran®. For more information about preferred products, see the medical policy listed below.

Coverage determination guidelines

On July 1, 2021, the Medical Benefit Drug Policy titled Anti-Emetics for Oncology will be available at:

Prior to July 1, 2021, the policy can be accessed from:

How to submit prior authorization

If the member received anti-emetic drugs in an outpatient setting for a cancer diagnosis from May 1, 2021, through July 31, 2021, you DO NOT need to submit a prior authorization request until a new anti-emetic drug will be administered.

We will authorize the anti-emetic drug the member was receiving prior to Aug. 1, 2021, and the authorization will be effective until Jan. 31, 2022, unless a change in treatment is needed.

Please complete all notifications online. Sign into the UnitedHealthcare Provider Portal using your One Healthcare ID and select the Prior Authorization and Notification tool. Once you are in the tool, select Oncology, and when prompted, answer the questions about the service type, member type and state. You can submit authorizations for anti-emetics on July 1, 2021, in advance of the Aug. 1, 2021, requirement.

Questions?

For online requests, call 888-397-8129, 8 a.m.–5 p.m., Monday–Friday local time. Visit Prior Authorization for Chemotherapy and Related Cancer Therapies for more information.

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