Site of Care – specialty infusion program
Moda Health partners with Prime Therapeutics Management LLC for medical pharmacy management, including the provider administered injectable medication and claim edit programs, to ensure our members receive quality and affordable care.
New prior authorization requirements
Effective Oct. 1, 2017, our partnership with Prime Therapeutics Management LLC will expand to include a Site of Care program that directs members to the most cost-effective, yet clinically appropriate, location to receive their infusion(s) of the select specialty medications (see medication list, below).
The Site of Care program will apply to all fully insured Commercial members and to all EOCCO members who begin using these medications on or after Oct. 1. Members currently using these medications will be subject to the Site of Care program requirements upon prior authorization renewal on or after Oct. 1. They will be notified of this change by Aug. 1, 2017.
Through the current prior authorization program administered by Prime Therapeutics Management LLC, infusion requests for a hospital outpatient setting for the listed medications will be redirected to a preferred site of service, which will be either preferred home infusion providers or a professional office setting. Infusions for these medications will not be covered when administered in a hospital outpatient infusion center.
The medications included in the Site of Care program already require prior authorization through Prime Therapeutics Management LLC. The Site of Care program requirements will be administered as part of the existing prior authorization program. As a reminder, Moda will deny services as provider responsibility when prior authorization is not obtained for any medications that require prior authorization.
Site of Care medication prior authorization list
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We're here to help. To learn more about Moda's Site of Care program, please email
or call us toll-free at 877-605-3229. TTY users, please call 711.
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