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Medical Benefit Coverage Changes

Wednesday, July 31, 2019

Changes to Existing Prior Authorization Programs
Effective for fill dates on or after October 1, 2019, CarePartners of Connecticut will require medical prior authorization for Octagam® and Synagis®. These changes will apply to members currently utilizing one of these medications, as well as members initiating a new course of treatment. For these requests, the prescribing provider must request coverage through the medical review process subject to the applicable medical necessity guidelines, including Medicare National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).