Beginning January 1, 2011, new Dosing and Frequency Requirements will be applied to the precertification process for eight drugs (please see the December edition of Partners in Health UpdateSM for more information about this change). Only new requests and extensions to existing authorizations for these drugs will be affected by these new requirements.
To help providers understand this change, the NaviNet® Chemotherapy/Infusion and Home Infusion Authorizations Guide is now available on the NaviNet® web portal in the Administrative Tools & Resources section. This guide includes sample screen shots of the NaviNet transactions and examples of the clinical question sets that will need to be completed when requesting these drugs for members.
The new clinical question sets are also available in the medical policy for each of the affected drugs. To view the clinical question sets in the medical policy, go to www.ibx.com/medpolicy, select Accept and Go to Medical Policy Online, and then type the drug name into the Search box. Select Attachment B in the Associated Attachments section of the medical policy.
Note: There are no clinical question sets available for onabotulinumtoxinA (Botox®).