Prior authorization updates for medications billed under the medical benefit

Effective for dates of service on or after March 1, 2025, the following medication codes will require prior authorization.

Please note that the inclusion of a National Drug Code (NDC) on your medical claim is necessary for claims processing.

Visit the Clinical Criteria website to search for the specific Clinical Criteria listed below.

What if I need assistance?

If you have any 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: Prior authorization requests for certain medications may require additional documentation to determine medical necessity.