[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-287646-105":53,"doc-detail-287646-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","dmba-medical-specialty-drug-program-frequently-asked-questions","DMBA Medical Specialty Drug Program - Frequently Asked Questions","","DMBA Medical Specialty Drug Program provides participants access to specialty medications using evidence-based, nationally recognized clinical criteria. Specialty drug coverage requires prior authorization and must meet utilization management criteria, be medically necessary as defined by the plan, and satisfy DMBA benefit eligibility requirements. The program is administered by Archimedes beginning July 1, 2022, with prior authorization requests available via fax and a web-posted medication list updated quarterly.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":51,"@type":70,"position":76},"https://docshare.wps.com/template/general/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/dmba-medical-specialty-drug-program-frequently-asked-questions/287646/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/dmba-medical-specialty-drug-program-frequently-asked-questions/287646.png","ImageObject",442,249,{"name":88,"@type":89},"McGucket","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-24","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":76},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"Which participants are included in the DMBA Medical Specialty Drug Program?","Question",{"text":108,"@type":109},"The program applies to participants enrolled in Deseret Choice Hawaii, DMBA PPO 90, DMBA PPO 70, DMBA HA 80, and DMBA HSA 60.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"When does the program take effect through Archimedes?",{"text":113,"@type":109},"The effective date through Archimedes is July 1, 2022. Providers may initiate prior authorization requests starting June 25, 2022 for medications administered on or after July 1, 2022.",{"name":115,"@type":106,"acceptedAnswer":116},"How long does Archimedes take to complete urgent and non-urgent prior authorization requests?",{"text":117,"@type":109},"Urgent requests are completed within three business days. Non-urgent requests are completed within 10 business days after receiving the prior authorization request with all necessary information.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},287646,1790184594,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":50,"category_name":51,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":76,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":79,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":73},1236954412713,"https://us-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","DMBA Medical Specialty Drug Program  \nFrequently Asked Ques\u003Cons  \nDMBA is commiEed to providing parAcipants with access to high-quality health care consistent with evidence-based, naAonally recognized clinical criteria and guidelines. With this commitment in mind, and to ensure affordability for our parAcipants, we’re implemenAng a change in the way we manage certain medical specialty medicaAons. Archimedes is a specialty drug benefit management company andwill be administering this program for DMBA.  \nWhich par)cipants are included in this program?  \nThe program will apply to parAcipants enrolled in Deseret Choice Hawaii, DMBA PPO 90, DMBA PPO 70, DMBA HA 80, and DMBA HSA 60.  \nWhat is the impact on par)cipant benefits?  \nSpecialty medicaAons are subject to prior authorizaAon. To be covered, the therapy must meet the uAlizaAon management criteria; be medically necessary, as defined by the Plan; and meet DMBA’s benefit eligibility requirements.  \nWhat is the effec)ve date of the program?  \nThis program has been in effect; however, the vendor helping administer the program is changing to Archimedes. The effecAve date of this program through Archimedes is July 1, 2022. For medicaAons tobe administered on or a_er July 1, 2022, providers may iniAate a request for prior authorizaAon directly with Archimedes starAng on June 25, 2022.  \nWhich medical specialty drug treatments will require a prior authoriza)on review by Archimedes?  \nPlease refer to the list posted on the Archimedes website at the Provider secAon of the DMBA website at [www.dmba.com/provider](www.dmba.com/provider).  \nHow o@en is the medica)on list updated?  \nThe list of medicaAons included in the Medical Specialty Drug Program is updated quarterly. When calling for a prior authorizaAon review, please check the list of medicaAons posted on the Archimedes website [at](at www.archimedesrx.com/resources or)[ ](at www.archimedesrx.com/resources or)[www.archimedesrx.com/resources](at www.archimedesrx.com/resources or)[ or](at www.archimedesrx.com/resources or) the Provider secAon of the DMBA website at [www.dmba.com/provider](www.dmba.com/provider).  \nAt which places of service (POS) does the medical specialty drug prior authoriza)on apply?  \nPrior authorizaAons are required for medicaAons administered at the following places of service:  \n• Physician Office (POS 11)  \n• OutpaAent Facility (POS 19, 22)  \n• In Home (POS 12)  \nARCFAQEN1PDN0425  \n© 2022 Archimedes Proprietary & ConfidenAal 1  \nPLEASE NOTE: Any prior authorizaAon required by the Plan for ancillary services, including theadministraAon of the drug, should be pre-authorized through DMBA, not Archimedes.  \nHow do providers contact Archimedes to request a prior authoriza)on (PA) or re-authoriza)on?  \nFax all PA requests to Archimedes at 866-491-6971. The general PA form can be obtained at [www.archimedesrx.com/resources or www.dmba.com/provider](www.archimedesrx.com/resources or www.dmba.com/provider).  \nFor addiAonal informaAon, call Archimedes at 888-504-5563 Monday through Friday, [8 a. m. to 6 p. m](8 a. m. to 6 p. m). Central Time.  \nThe provider should include the following informaAon with the PA form/request:  \n• ParAcipant name, date of birth, and ID number  \n• DMBA health plan name  \n• Ordering provider name, NPI, address, and office telephone and fax numbers  \n• Requested drug name or HCPCS code  \n• Dosing informaAon and frequency  \n• Diagnosis (ICD-10 code)  \n• Chart notes (including clinical notes, laboratory, and/or radiology results, etc. ) supporAng the case with clinical informaAon perAnent to the request  \nIt is the responsibility of the provider to obtain prior authorizaAon before services are provided. If the ordering provider and the rendering provider are different, the rendering provider is responsible for ensuring that the appropriate approval is on file prior to rendering services.  \nWhat if Archimedes does not have all the necessary informa)on to make a determina)on on a prior authoriza)on request?  \nIf A","cbCaikd62yRp3hsy","https://ap.wps.com/l/cbCaikd62yRp3hsy","pdf",99614,"English","# Frequently Asked Questions\n## Program overview and included participants\n## Coverage requirements and effective date\n## Medication list updates and treatment reviews\n## How to request prior authorization","[{\"question\":\"Which participants are included in the DMBA Medical Specialty Drug Program?\",\"answer\":\"The program applies to participants enrolled in Deseret Choice Hawaii, DMBA PPO 90, DMBA PPO 70, DMBA HA 80, and DMBA HSA 60.\"},{\"question\":\"When does the program take effect through Archimedes?\",\"answer\":\"The effective date through Archimedes is July 1, 2022. Providers may initiate prior authorization requests starting June 25, 2022 for medications administered on or after July 1, 2022.\"},{\"question\":\"How long does Archimedes take to complete urgent and non-urgent prior authorization requests?\",\"answer\":\"Urgent requests are completed within three business days. Non-urgent requests are completed within 10 business days after receiving the prior authorization request with all necessary information.\"}]","DMBA Medical Specialty Drug Program - Frequently Asked Questions | PDF",1789632572]