Notice of Material Amendment to Healthcare Contract: Prior authorization updates for medications billed under the medical benefit 

Effective November 1, 2023, the following medication codes will require prior authorization. 

Please note, inclusion of a national drug code on your medical claim is necessary for claims processing. 

Visit the Clinical Criteria website to search for the following Clinical Criteria:

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your local Provider Relationship Management representative or call Provider Services at 855-661-2028.

Note: Prior authorization requests for certain medications may require additional documentation to determine medical necessity.