1/29/2025
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Posted by Provider Relations
The following codes have been removed from the Medicaid and Essential Plan Authorization Grids and do not require prior authorization:
J0739 cabotegravir inj
J0741 cabotegrvir and rilpivirine inj
J0750 emtricitabine tenofovir df, oral for PReP
J0751 emtricitabine tenofovir alafenamide, oral for PReP
J0799 unclassified FDA approved PReP drugs
J1746 ibalizumab-uiyk (Trogarzo)
J1961 lenacapavir (Sunlenca)
Q0521 Pharmacy supplying fee for HIV pre-exposure prophylaxis FDA approved prescription
S0104 zidovudine oral
S0140 saquinavir oral
Visit: Authorization Grids