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Prior Authorization – Injectable Medications

Injectable Medications are managed by HCPs highly regarded pharmacy department. The team provides recommendations for appropriate drug choice, dosing, and expected outcomes, all while ensuring your patients get the most value out of medication therapy.

HCP covers drug therapy in the home, in provider offices, and in the hospital setting. When treatment is available safely in the home or office, these are the preferred sites of service. The pharmacy team can assist with arranging home infusion therapy quickly and efficiently.

The following medications are available for use by providers without prior authorization. Medications not found on the list require that a Prior Authorization Request be submitted for review.

A request for Prior Authorization may be submitted to HCP in one of two ways.

  1. The preferred and most efficient way to submit a Prior Authorization (PA) request is via the HCP Web-based data interface, EZ-Net.

    Login credentials for EZ-Net are required. Learn More

  2. PA requests may also be submitted via FAX by sending a completed request form to 888-746-6433 or 516-746-6433.

View and download a printable copy of HCP’s Authorization Request form here.

These medications require no prior authorization:

J0210METHYLDOPATE HCL INJECTION
J0280AMINOPHYLLIN 250 MG INJ
J0330SUCCINYCHOLINE CHLORIDE INJ
J0390CHLOROQUINE INJECTION
J0461ATROPINE SULFATE INJECTION
J0515INJ BENZTROPINE MESYLATE
J0520BETHANECHOL CHLORIDE INJECT
J0595BUTORPHANOL TARTRATE 1 MG
J0706CAFFEINE CITRATE INJECTION
J0720CHLORAMPHENICOL SODIUM INJEC
J0745INJ CODEINE PHOSPHATE /30 MG
J1130INJ DICLOFENAC SODIUM 0.5MG
J1162DIGOXIN IMMUNE FAB (OVINE)
J1165PHENYTOIN SODIUM INJECTION
J1170HYDROMORPHONE INJECTION
J1230METHADONE INJECTION
J1245DIPYRIDAMOLE INJECTION
J1250INJ DOBUTAMINE HCL/250 MG
J1320AMITRIPTYLINE INJECTION
J1327EPTIFIBATIDE INJECTION
J1330ERGONOVINE MALEATE INJECTION
J1380ESTRADIOL VALERATE 10 MG INJ
J1430ETHANOLAMINE OLEATE 100 MG
J1450FLUCONAZOLE
J1610GLUCAGON HYDROCHLORIDE/1 MG
J1644INJ HEPARIN SODIUM PER 1000U
J1726MAKENA, 10 MG
J1730DIAZOXIDE INJECTION
J1741IBUPROFEN INJECTION
J1800PROPRANOLOL INJECTION
J1817INSULIN FOR INSULIN PUMP USE
J1940FUROSEMIDE INJECTION
J1953LEVETIRACETAM INJECTION
J1980HYOSCYAMINE SULFATE INJ
J1990CHLORDIAZEPOXIDE INJECTION
J2001LIDOCAINE INJECTION
J2210METHYLERGONOVIN MALEATE INJ
J2300INJ NALBUPHINE HYDROCHLORIDE
J2310INJ NALOXONE HYDROCHLORIDE
J2547INJECTION, PERAMIVIR
J2550PROMETHAZINE HCL INJECTION
J2560PHENOBARBITAL SODIUM INJ
J2590OXYTOCIN INJECTION
J2704INJ, PROPOFOL, 10 MG
J2710NEOSTIGMINE METHYLSLFTE INJ
J2785REGADENOSON INJECTION
J2795ROPIVACAINE HCL INJECTION
J2800METHOCARBAMOL INJECTION
J2810INJ THEOPHYLLINE PER 40 MG
J2950PROMAZINE HCL INJECTION
J3105TERBUTALINE SULFATE INJ
J3230CHLORPROMAZINE HCL INJECTION
J3246TIROFIBAN HCL
J3265INJECTION TORSEMIDE 10 MG/ML
J3300TRIAMCINOLONE A INJ PRS-FREE
J3301TRIAMCINOLONE ACET INJ NOS
J3360DIAZEPAM INJECTION
J3471OVINE, UP TO 999 USP UNITS
J3472OVINE, 1000 USP UNITS
J3530NASAL VACCINE INHALATION
J3535METERED DOSE INHALER DRUG
J7030NORMAL SALINE SOLUTION INFUS
J7040NORMAL SALINE SOLUTION INFUS
J70425% DEXTROSE/NORMAL SALINE
J7050NORMAL SALINE SOLUTION INFUS
J70605% DEXTROSE/WATER
J7070D5W INFUSION
J7100DEXTRAN 40 INFUSION
J7110DEXTRAN 75 INFUSION
J7120RINGERS LACTATE INFUSION
J71215% DEXTROSE IN LAC RINGERS
J7131HYPERTONIC SALINE SOL
J7297LILETTA, 52 MG
J7298MIRENA, 52 MG
J7300INTRAUT COPPER CONTRACEPTIVE
J7301SKYLA, 13.5 MG
J7303CONTRACEPTIVE VAGINAL RING
J7304CONTRACEPTIVE HORMONE PATCH
J7306LEVONORGESTREL IMPLANT SYS
J7307ETONOGESTREL IMPLANT SYSTEM
J7512PREDNISONE IR OR DR ORAL 1MG
J7518MYCOPHENOLIC ACID
J7520SIROLIMUS, ORAL
J7604ACETYLCYSTEINE COMP UNIT
J7605ARFORMOTEROL NON-COMP UNIT
J7606FORMOTEROL FUMARATE, INH
J7607LEVALBUTEROL COMP CON
J7608ACETYLCYSTEINE NON-COMP UNIT
J7609ALBUTEROL COMP UNIT
J7612LEVALBUTEROL NON-COMP CON
J7620ALBUTEROL IPRATROP NON-COMP
J7622BECLOMETHASONE COMP UNIT
J7627BUDESONIDE COMP UNIT
J7628BITOLTEROL MESYLATE COMP CON
J7629BITOLTEROL MESYLATE COMP UNT
J7631CROMOLYN SODIUM NONCOMP UNIT
J7633BUDESONIDE NON-COMP CON
J7634BUDESONIDE COMP CON
J7635ATROPINE COMP CON
J7636ATROPINE COMP UNIT
J7637DEXAMETHASONE COMP CON
J7638DEXAMETHASONE COMP UNIT
J7639DORNASE ALFA NON-COMP UNIT
J7640FORMOTEROL COMP UNIT
J7642GLYCOPYRROLATE COMP CON
J7643GLYCOPYRROLATE COMP UNIT
J7644IPRATROPIUM BROMIDE NON-COMP
J7645IPRATROPIUM BROMIDE COMP
J7667METAPROTERENOL COMP CON
J7668METAPROTERENOL NON-COMP CON
J7669METAPROTERENOL NON-COMP UNIT
J7670METAPROTERENOL COMP UNIT
J7674METHACHOLINE CHLORIDE, NEB
J7680TERBUTALINE SULF COMP CON
J7681TERBUTALINE SULF COMP UNIT
J7682TOBRAMYCIN NON-COMP UNIT
J7683TRIAMCINOLONE COMP CON
J7684TRIAMCINOLONE COMP UNIT
J7685TOBRAMYCIN COMP UNIT
J7699INHALATION SOLUTION FOR DME
J7799NON-INHALATION DRUG FOR DME