To ensure optimum performance of this website you may want to enable Javascript.

sdmedx
Home Page
Alert:    

Prior Authorization

Makena®

Makena® is FDA approved to reduce the risk of preterm birth in women with a singleton pregnancy who have a history of singleton spontaneous preterm birth. Makena® is not intended for use in women with multiple gestations or other risk factors for preterm birth.*

Makena® requires prior authorization. Since Makena cannot be administered by the patient it is classified as physician administered. Physician administered drugs are not covered through the Medicaid pharmacy benefit and can not be billed by pharmacies; these agents must be billed by the prescribing physician or their facility.

Approval Criteria

* Recipient has a history of singleton spontaneous preterm birth and is currently pregnant with a singleton.

Approval will be granted for treatment beginning between weeks 16 and 20 of gestation and continuing until week 37 of gestation or delivery, whichever occurs first.

Documentation Requirements for Prior Authorization Requests:

Submit completed documentation to:

  • Department of Social Services
    Division of Medical Services
    Nurse Consultant
    700 Governors Drive
    Pierre, SD 57501
  • Phone: 605-773-3495
  • Fax: 605-773-5246