J9017, Injection, arsenic trioxide, 1 mgHCPCS/CPT
Prior Auth Required
Code explicitly requires prior authorization (high confidence)
BCBSNJ-DRUGS-177-B3FBA7716F, Arsenic Trioxide (Trisenox)
NJ
EVICORE-HPLAN-CIGNA-729A536F50C8
EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-4BC80209CCC5, Q3 - 2026 Jefferson Health Plans MedOnc Master Drug List
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