To assist prescribers and providers, prior authorization (PA) requirements can be bypassed for certain medications when specific medical conditions exist. Those specific medications and diagnoses can be found here. Prescribers are encouraged to include the applicable diagnosis code on written prescriptions for inclusion on the electronic pharmacy claim. The submitted claim should include a Diagnosis Code Qualifier (Field # 492-WE) of “02,” indicating ICD-10, as well as the appropriate Diagnosis Code (Field # 424-DO).
If you have any questions, contact the OptumRx Pharmacy Supports Center at 866-434-5520 or tnrxeducation@optum.com.
Also in Tennessee, the October 31 Drug Utilization Committee (DUR) Board meeting will be held virtually via Microsoft Teams. Please Click Here or Phone number: +1 952-222-7450 Phone Conference ID: 857 579 147#
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.