Physician Administered Drugs

Frequently Asked Questions

Pharmaceutical Benefit Help Guide

Prior Authorizations

The Department has announced the intent to award the Utilization Management (UM) contract to Keystone Peer Review Organization (KEPRO). KEPRO will replace eQHealth Solutions, Inc as the UM Vendor in Spring of 2021.

Additionally, the Department will be adding a select group of Physician Administered Drugs (PADs) to require prior authorization that will be implemented with KEPRO. Information pertaining to PAD prior authorization requests will be posted on this page within the coming weeks. Proposed PADs to be prior authorized will be reviewed at the February Drug Utilization Review (DUR) Board meeting; DUR specific information can be found on the DUR web page.

Fee for Service Physician Administered Drugs

COMING SOON: Appendix Y - Physician Administered Drug Medical Benefit Prior Authorization Procedures and Criteria

Outpatient Hospital Specialty Drugs - EAPG Carveout

Other Resources and Links

Contact Information

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