The documents below list services and medications that require prior authorization for patients with Medicaid, Medicare Advantage and dual Medicare-Medicaid coverage.
New prior authorization search tool
Search by CPT code, procedure or drug name to see if prior authorization is required.
Medicare Part B Step Therapy Preferred Drug List change notifications
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Medicare Part B Step Therapy Preferred Drug List change notifications
Current preauthorization and notification lists
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January 1, 2025, Part B Step Preferred Drug List -
January 1, 2025, Humana Gold Plus Integrated Illinois Dual Medicare-Medicaid Plan Preauthorization and Notification List -
January 1, 2025, Humana Gold Plus® Integrated Medicare-Medicaid Illinois Long-Term Services and Supports (LTSS) Plan Preauthorization and Notification List (PAL) -
January 1, 2025, Medicare Advantage and Dual Eligible Special Needs Plans Preauthorization and Notification List -
January 1, 2025, Puerto Rico Medicare and Dual Medicare-Medicaid Prior Authorization and Notification List
Previous preauthorization and notification lists
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July 1, 2024, Part B Step Preferred Drug List -
July 1, 2024, Humana Gold Plus Integrated Illinois Dual Medicare-Medicaid Plan Preauthorization and Notification List -
January 1, 2024, Humana Gold Plus® Integrated Medicare-Medicaid Illinois Long-Term Services and Supports (LTSS) Plan Preauthorization and Notification List (PAL) -
July 1, 2024, Medicare Advantage and Dual Eligible Special Needs Plans Preauthorization and Notification List -
January 1, 2024, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List
January 1, 2024, Puerto Rico Medicare and Dual Medicare-Medicaid Prior Authorization and Notification List
Prior authorization resources
Use the links below to submit the prior authorization form, find other forms or learn more about the process.
Ready to submit
Submit or manage your prior authorization on Availity.
Coverage criteria
Search coverage, medical and pharmacy criteria.
Fax forms
Download a form to submit your prior authorization by fax.
State exemptions
For more information, please see the FAQs below for specific state exemptions.
Texas exemptions
Louisiana exemptions