MedicaidPrior AuthMedium impact
Updated Coverage for Procedure Code J0638
Arkansas Medicaid·AR · Pharmacy·Pharmacy
Effective date
Jun 15, 2026
We identified it
Jun 28, 2026
Summary
Arkansas Department of Human Services now requires Prior Authorization for procedure code J0638 (Canakinumab Injection) across all provider types (ASC, Hospital, Physician) effective June 15, 2026. Additionally, diagnosis codes from Group 659 are no longer required for coverage of this drug.
Action Required
By June 15, 2026: Billing team must update billing system to require prior authorization for HCPCS code J0638 for all patient ages 4 years and older across AMBSC, MEDSV, and OUTPA provider contracts. Providers must submit PA requests to Prime Therapeutics Pharmacy Call Center at (800) 424-7895 (Option 1 for pharmacy support) or via website ar.primetherapeutics.com before dispensing. Remove any billing logic requiring Group 659 diagnosis codes for J0638 claims. Update encounter documentation to remove Group 659 diagnosis code mandates. Failure to obtain prior authorization will result in claim denials. Train clinical and billing staff on new PA process and contact information.