The documents below list services and medications that require prior authorization for patients with Medicaid, Medicare Advantage, dual Medicare-Medicaid and commercial coverage.

New prior authorization search tool

Search by CPT code, procedure or drug name to see if prior authorization is required. 

Medicare

Medicare preauthorization list summary of changes

  • Medicare Medical Preauthorization List Summary of Changes
  • Medicare Medication Preauthorization List Summary of Changes
  • Puerto Rico Prior Authorization List With Summary of Changes

Current preauthorization and notification lists (Effective July 1, 2024)

  • Part B Step Preferred Drug List
  • Humana Gold Plus Integrated Illinois Dual Medicare-Medicaid Plan Preauthorization and Notification List
  • Medicare Advantage and Dual Eligible Special Needs Plans Preauthorization and Notification List
  • Puerto Rico Medicare and Dual Medicare-Medicaid Prior Authorization and Notification List

Future preauthorization and notification lists (Effective January 1, 2025)

  • Part B Step Preferred Drug List
  • Humana Gold Plus Integrated Illinois Dual Medicare-Medicaid Plan Preauthorization and Notification List
  • Medicare Advantage and Dual Eligible Special Needs Plans Preauthorization and Notification List

Previous preauthorization and notification lists

  • January 1, 2024, Humana Gold Plus Integrated Illinois Dual Medicare-Medicaid Plan 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
  • July 1, 2023, Humana Gold Plus Integrated Illinois Dual Medicare-Medicaid Plan Preauthorization and Notification List
  • July 1, 2023, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List
  • July 1, 2023, Part B Step Preferred Drug List
  • January 1, 2023, Humana Gold Plus Integrated Illinois Dual Medicare-Medicaid Plan Preauthorization and Notification List
  • January 1, 2023, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List
CommercialMedicaidState-specific prior authorization statistics

Preauthorization resources

Use the links below to submit the preauthorization form, find other forms or learn more about the process.

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Coverage criteria

Search coverage, medical and pharmacy criteria.

Medical and pharmacy coverage criteria

Medical coverage criteria updates and recent changes

Fax forms

Download a form to submit your preauthorization by fax.

Standard form

Texas form

New Mexico form

Indiana form

Arizona form

State exemptions

For more information please see the FAQs below for specific state exemptions.

Texas exemptions

Texas House Bill 3459 – Preauthorization Exemptions

Louisiana exemptions

Louisiana Senate Bill 112 – Preauthorization Exemptions

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