Injectable drugs requiring prior authorization

Kaiser Permanente requires prior authorization of certain injectable medications administered in the office or home infusion setting. These reviews ensure that benefits are adjudicated and that use is in line with Pharmacy & Therapeutics Committee criteria.

Review Timeframes

Medicare:

Expedited requests: No later than 24 hours from receipt of the prescriber’s supporting statement.

Standard request: No later than 72 hours from receipt of the prescriber’s supporting statement.

Commercial:

Non ePA expedited requests: No later than 2 calendar days from Receipt of request if all information is provided.

Non ePA standard requests: No later than 5 calendar days from Receipt of request if all information is provided.

ePA expedited requests: No later than 1 calendar days from Receipt of request if all information is provided.

ePA standard requests: No later than 3 calendar days from Receipt of request if all information is provided.

NOTE: For standard requests: If Kaiser Permanente contacts the provider for additional information, please respond within 5 calendar days. If the supporting statement is sufficient, we will render our decision and provide notification within 4 calendar days of receipt of your statement.

For Expedited requests: If Kaiser Permanente contacts the provider for additional information for an expedited request, please respond within 2 calendar days. We will render our decision and provide notification within 2 calendar days of receipt of your statement.

Current lists of injectable drugs requiring prior authorization:

• Non-Medicare drug list (PDF)
• Medicare Advantage drug list (PDF)
• Medicare Part B step therapy (PDF)

Kaiser Permanente’s preferred biosimilar products:

• Biosimilar FAQ (PDF)

Policies regarding site of care and site of service:

• Infusion Site of Care Policy (PDF)
• Infusion Site of Service Policy (PDF)