MedicaidPrior AuthHigh impact
Drugs and Services Carved Out of Physician Administered Drug Prior Authorizations Submitted to Prime Therapeutics
Arkansas Medicaid·AR · Oncology, Hematology, Transplant Surgery +4 more·Pharmacy
Effective date
Feb 2, 2026
We identified it
Feb 2, 2026
Summary
Arkansas DHS has transitioned Physician Administered Drug (PAD) prior authorizations to Prime Therapeutics, but specific drugs and services remain carved out and must continue to be submitted through alternative channels: transplant medications and sickle cell gene therapies to Utilization Review, skin substitutes and radiopharmaceuticals to the Medicaid Provider Portal under Professional Services (PT 126), knee injections under Viscosupplementation (PT 113), and allergy injections under Professional Services (PT 126). Providers may also submit reconsideration requests via the Provider Portal for previously denied PAD PAs from AFMC.
Action Required
Immediately: Billing team must implement routing changes for carved-out PAD codes. (1) For J2562 (Mozobil), J3394 (Lvfgenia), and J3392 (Casgevy)—submit PA requests directly to Utilization Review using existing contact information, NOT to Prime Therapeutics. (2) For Q4186 (Epifix) and radiopharmaceuticals (A9513, A9595, A9607)—submit PAs via Medicaid Provider Portal at https://portal.mmis.arkansas.gov/armedicaid/provider/Home/tabid/135/Default.aspx under Professional Services PA Process Type (PT 126). (3) For knee injection codes J7318-J7332—submit PAs via the Provider Portal under Viscosupplementation PA Process Type (PT 113). (4) For allergy injections (no NDC required)—submit via Provider Portal under Professional Services PA Process Type (PT 126). Update internal routing logic in billing software to direct these specific codes away from Prime Therapeutics. Train billing staff on new submission pathways and Portal navigation. For any PAD PAs previously denied by AFMC, establish process to submit reconsideration requests via Provider Portal using the tracking number search function. Failure to route these carved-out codes correctly will result in claim denials and processing delays.