The documents below list services and medications that require prior authorization for patients with Medicaid, Medicare Advantage and dual Medicare-Medicaid coverage.
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 prior authorization list summary of changes
Current prior authorization and notification lists
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July 1, 2025, Humana Gold Plus® Integrated Illinois Dual Medicare-Medicaid Plan Prior Authorization and Notification List -
July 1, 2025, Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List -
July 1, 2025, Humana Dual Fully Integrated Virginia Prior Authorization and Notification List -
January 1, 2025, Part B Step Preferred Drug List -
January 1, 2025, Humana Gold Plus® Integrated Medicare-Medicaid Illinois Long-Term Services and Supports (LTSS) Plan Prior Authorization and Notification List (PAL) -
Effective July 1, 2025, Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Prior Authorization and Notification List
Future prior authorization and notification lists
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October 1, 2025, Humana Gold Plus Integrated Illinois Dual Medicare-Medicaid Plan Prior Authorization and Notification List -
October 1, 2025, Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
Previous prior authorization and notification lists
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January 1, 2025, Humana Gold Plus Integrated Illinois Dual Medicare-Medicaid Plan Prior Authorization and Notification List -
January 1, 2025, Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List -
January 1, 2025, Puerto Rico Medicare and Dual Medicare-Medicaid Prior Authorization and Notification List -
July 1 2024, Part B Step Preferred Drug List -
July 1 2024, Humana Gold Plus Integrated Illinois Dual Medicare-Medicaid Plan Prior Authorization and Notification List -
July 1 2024, Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List -
January 1, 2024, Puerto Rico Medicare and Dual Medicare-Medicaid Prior Authorization and Notification List
How to submit requests
Save time by reviewing what to include in your prior authorization.What to include in a prior authorization
Basic information
- Physician and facility information, including Tax Identification Number and National Provider Identifier (NPI) of requesting provider and servicing provider
- Patient name, date of birth and member ID
- Date of service
- Contact information for person who can provide clinicals and answer questions
Letter of medical necessity
- Summary statement of medical need and reason for request
Summary of patient’s diagnosis
- Date of diagnosis, diagnostic and imaging results
- Current severity of patient’s conditions
- Any previously attempted treatments or patient intolerance to these treatments
Summary of patient’s history
- Previously administered treatments, procedures and dates
- Response to these treatments
- Recent symptoms and conditions
- Physician opinion of patient prognosis and disease progression
What to include in a prior authorization
Basic information
- Physician and facility information, including Tax Identification Number and National Provider Identifier (NPI) of requesting provider and servicing provider
- Patient name, date of birth and member ID
- Date of service
- Contact information for person who can provide clinicals and answer questions
Letter of medical necessity
- Summary statement of medical need and reason for request
Summary of patient’s diagnosis
- Date of diagnosis, diagnostic and imaging results
- Current severity of patient’s conditions
- Any previously attempted treatments or patient intolerance to these treatments
Summary of patient’s history
- Previously administered treatments, procedures and dates
- Response to these treatments
- Recent symptoms and conditions
- Physician opinion of patient prognosis and disease progression
Prior authorization resources
Use the links below to submit the prior authorization form, find other forms or learn more about the process.
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