Countycare Coverage Criteria
Latest Countycare coverage criteria updates6
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Adakveo (crizanlizumab-tmca) Coverage Criteria for Sickle Cell DiseaseThis policy governs prior authorization under the CountyCare medical benefit for Adakveo in practitioners treating members with sickle cell disease. It establishes initial approval and annual reauthorization requirements for members age 16 or older.All countycare updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Enjaymo (sutimlimab-jome) Coverage CriteriaThis policy governs prior authorization for Enjaymo under the Health Plan medical benefit for adults with primary cold agglutinin disease. It applies to practitioners requesting or providing the drug and establishes initial and annual continuation criteria.All countycare updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Evkeeza (evinacumab-dgnb) Coverage CriteriaThis policy governs prior authorization under the Health Plan medical benefit for Evkeeza in adult and pediatric patients with homozygous familial hypercholesterolemia. It applies to practitioners involved in providing the requested drug and establishes initial and annual reauthorization requirements.All countycare updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-03-01Ryoncil (remestemcel-L-rknd) Coverage CriteriaThis guideline governs prior authorization for Ryoncil under the Health Plan's medical benefit for eligible pediatric members with acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation.All countycare updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-03-01Tepezza (teprotumumab-trbw) Prior Authorization for Thyroid Eye DiseaseThis guideline governs prior authorization for Tepezza under the Health Plan medical benefit for Medicaid members and establishes initial authorization criteria, dosing, documentation, and infusion limits.All countycare updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-08-01Entyvio (vedolizumab) Coverage CriteriaThis clinical guideline governs coverage review and authorization of Entyvio (vedolizumab) for providers. It addresses initial and reauthorization criteria for Crohn's disease, ulcerative colitis, and immune checkpoint inhibitor-related toxicity.All countycare updates
Tool Description
Search Countycare coverage criteria and medical necessity requirements across 21,000+ policies from 170+ payers.
Search a drug (“Wegovy”), a procedure (“knee replacement”), or a policy name, then filter by payer, specialty, policy type, or effective year. Or start from the largest publishers: UnitedHealthcare coverage criteria and Cigna coverage criteria.
Each result links the full policy page, which lists the clinical requirements, covered codes, and effective dates from the source document.
Pair a criteria search with the prior authorization lookup for approval requirements, the timely filing lookup for claim deadlines, the live policy updates feed for the newest payer publications, and payer profiles for contacts and coverage context.
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