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Arkansas MedicaidMedicaid · Coverage · Pharmacy · AR · Neurology, Geriatrics, Internal Medicine +1 moreMedium impact

Coverage Added for J0174 and J0175

Act
by Apr 28, 2026
Effective date
Apr 28, 2026
Identified
Jun 5, 2026

Summary

Arkansas Department of Human Services (OUTPA contract) has expanded coverage to include two new monoclonal antibody injection codes: J0174 (Lecanemab-irmb/Leqembi) for patients 50+ years and J0175 (Donanemab-azbt/Kisunla) for patients 60+ years, effective April 28, 2026. Both codes require prior authorization and medical review.

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What to do

by Apr 28, 2026 · 6 steps
01Billing team must update billing system to recognize J0174 and J0175 as covered codes on Arkansas OUTPA plans.
02Configure system to require prior authorization for both codes before claim submission.
03Update encounter templates and clinical staff rosters to flag these codes as requiring medical review and prior auth.
04Establish workflow with providers to request prior authorization through Prime Therapeutics Pharmacy Call Center (800-424-7895, Option 1 or web at ar.primetherapeutics.com) before patient administration.
05Verify patient age eligibility (50+ for J0174, 60+ for J0175) during pre-authorization process.
06Maintain contact information for Prime Therapeutics and Provider Assistance Center ((800) 457-4454 or (501) 376-2211) for authorization questions.
If missed: Failure to obtain prior authorization will result in claim denials.

Codes mentioned

J0174J0175

Original notice

Coverage Added for J0174 and J0175
humanservices.arkansas.gov · Always check the source before changing claims.
View original ↗

Related policy hubs

Arkansas Medicaid policiesAR policy changesNeurologyGeriatricsInternal MedicinePharmacyCode J0174Code J0175

Summaries are AI-assisted. Always confirm against the original payer notice.

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