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1199SEIU Funds Implementation Resources

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To ease providers’ administration of medical specialty drug benefits to their 1199SEIU patients, effective March 1, 2025, the 1199SEIU Benefit Funds (“Funds”) will leverage its existing partnership with EviCore to manage the Funds’ Medical Specialty Drug Prior Authorization Program. EviCore will review specialty drug authorizations for certain medical drugs that are bought, billed and administered in an outpatient setting, or gene therapies in an inpatient setting, including review of appropriateness of units billed. Please note: Also effective March 1, the Medical Specialty Drug Prior Authorization Program (formerly known as the Medical Drug Management Program) will no longer be managed by CareContinuum.

We encourage you to attend one of the EviCore online orientation sessions. Click on the Solutions Resources tab for the orientation schedule and registration details. 

 

Effective 1/1/2023, 1199SEIU Benefit Funds Medical Oncology prior authorization program will begin accepting prior authorization requests for pediatric and adult Medical Oncology outpatient clinical drug trials through EviCore healthcare. The new process will still be submitted through http://www.EviCore.com, or by phoning 888-910-1199.

 

Effective 10/1/2021, 1199SEIU Benefit Funds Medical Oncology prior authorization program will incur a slight change in oncology based primary treatment regimen requests with the Biosimilar First Program. The program steers to the use of preferred products within the trastuzumab, bevacizumab, and rituximab therapeutic classes. The utilization of at least one preferred product will be required prior to the approval of a non-preferred product. The new process will still be submitted through www.EviCore.com, or by phoning 888-910-1199. Both preferred and non-preferred products still require prior authorization. Selection from the list will be made and a clinical questionnaire will be completed to confirm medical necessity.

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Registration Instructions

EviCore highly recommends providers take full advantage of the online capabilities at https://www.evicore.com/provider

Here you can request prior authorization, review our nationally accepted evidence-based guidelines, and receive announcements about program updates. Access requires only your email address and a brief registration.

Register for Online Portal Orientation Session

Evidence-Based Clinical Guidelines