CenCal CareConnect covers certain medications under the Medicare Part B benefit when they are administered in a physician’s office, clinic, outpatient facility, or home setting. On a quarterly basis, CenCal CareConnect reviews newly released medication codes to determine appropriate placement under the Part B benefit.
The CenCal CareConnect Pharmacy and Therapeutics Committee has approved the prior authorization status for the medication codes listed below.
Effective April 1, 2026, the identified medication codes will require prior authorization.
For a complete list of medication codes requiring prior authorization, please refer to the Medicare Part B Prior Authorization List available on the CenCal CareConnect website.
If you have questions or need additional information, please contact CenCal CareConnect Pharmacy Department at (805) 562-1080.
| Drug Name | Active Ingredients | Route of Admin. | HCPCS Code | Prior Authorization (PA) Status |
| Spravato | Esketamine | Nasal | J0013 | PA Required |
| Testopel | Testosterone Pellet | Implant | J1073 | PA Required |
| Noxafil | Posaconazole | IV | J1837 | PA Required |
| Skysona | Elivaldogene Autotemcel | IV | J3387 | PA Required |
| Zevaskyn | Prademagene Zamikeracel | IV | J3389 | PA Required |
| Imaavy | Nipocalimab | IV | J9256 | PA Required |
| Zusduri | Mitomycin | Intravesical | J9282 | PA Required |
| Emrelis | Telisotuzumab Vedotin | IV | J9326 | PA Required |