Inpatient Notification and Drug Prior Authorization for Zynteglo
CarePartners of Connecticut now requires prior authorization for coverage of Zynteglo, a gene therapy indicated for the treatment of transfusion-dependent (severe) beta-thalassemia.
Please be aware that coverage of Zynteglo will require two separate points of contact with CarePartners of Connecticut: a prior authorization request for the drug itself, followed by an acute inpatient notification.
Because Zynteglo is administered in an acute inpatient setting, facilities will need to submit an inpatient notification in accordance with the information contained in the Referrals, Prior Authorizations, and Notifications section of our Provider Manual, and the notification must include the drug code for Zynteglo (HCPCS J3590).
Keep in mind, however, that prior authorization for the drug must be obtained before the inpatient stay is planned by submitting a separate prior authorization request to CarePartners of Connecticut. If a patient is admitted to an acute inpatient facility and Zynteglo is administered but coverage of the drug has not already been authorized beforehand, the facility may not receive payment for the administration of the drug.
As detailed in this article within this issue of Provider Update, you now have access to a new online prior authorization tool, PromptPA, for both pharmacy and medical benefit drug prior authorization requests. PromptPA can be accessed through our Provider Portal or directly at https://point32health.promptpa.com/. Online submission enables you to view drug-specific criteria, attach clinical information, check the status of your request, and receive a response more quickly.Alternatively, you may request authorization via FAX at 617-673-0956.
For more information, please refer to our new Zynteglo Medical Necessity Guidelines.