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 preauthorization list summary of changes
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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)
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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)
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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
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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
Preauthorization resources
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Coverage criteria
Search coverage, medical and pharmacy criteria.
Fax forms
Download a form to submit your preauthorization by fax.
State exemptions
For more information please see the FAQs below for specific state exemptions.
Texas exemptions
Louisiana exemptions