MedicaidPrior AuthMedium impact
Provider Letter 2024-13: RE: Prior Authorization of Aliqopa® – Effective July 1, 2024
Oklahoma SoonerCare·OK · Oncology, Hematology·Prior Authorization
Effective date
Jul 1, 2024
We identified it
Jun 20, 2026
Summary
Oklahoma Health Care Authority (OHCA) will require prior authorization for Aliqopa® (copanlisib) effective July 1, 2024. Current patients can continue therapy, but new patients will generally not be approved, and specific criteria must be met including diagnosis of relapsed/refractory Follicular Lymphoma and two or more failed prior systemic therapies.
Action Required
By July 1, 2024: Billing team must implement prior authorization requirements for Aliqopa® (copanlisib) prescriptions for SoonerCare members. Use form PHARM-162 available at oklahoma.gov/ohca/rxforms and submit to Pharmacy Prior Authorization Unit at fax number on form. For members who started therapy after June 1, 2024, submit PA request immediately to avoid therapy disruption. Document dates of previous doses on PA form for members already receiving therapy. Claims without prior authorization will be denied.