Prior authorization updates for medications billed under the medical benefit

Effective November 1, 2023, the following medication codes billed on medical claims will require prior authorization (PA).

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 specific Clinical Criteria listed below.

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 855-558-1443.

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