Blue Choice

South Carolina Healthy Connections

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Prior Authorization Requirements for Sublocade

November 19, 2018

Effective February 1, 2019, prior authorization (PA) requirements will change for the infusible/injectable drug Sublocade to be covered by Healthy Blue. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions/exclusions, take precedence over these PA rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

PA requirements will be added to the following:

  • Sublocade (Buprenorphine) — implant (J0570)
  • Sublocade — injectable (Q9991, Q9992)

To request PA, you may use one of the following methods:

Availity is an independent company that administers the secure provider portal on behalf of BlueChoice HealthPlan.

Not all PA requirements are listed here. PA requirements are available to contracted providers through the Availity Portal (https://www.availity.com). Providers who are unable to access Availity may call us at 1-866-757-8286 for PA requirements.

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