UPMC Health Plan Coverage Criteria
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Latest UPMC Health Plan coverage criteria updates25
- Coverage CriteriaClinical/Medical PolicyAceclidine (Vizz) CoverageThe available document content identifies a Medicaid policy concerning aceclidine (Vizz), but the substantive coverage criteria and authorization requirements are not present in the supplied text.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyAdzynma (recombinant ADAMTS13) Coverage CriteriaThis document appears to concern UPMC Health Plan Medicaid coverage and prior authorization for Adzynma (recombinant ADAMTS13). The available source text contains only PDF viewer metadata and does not provide clinical coverage criteria or authorization requirements.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyAfamelanotide (Scenesse) - MedicaidThe available source content identifies a UPMC Health Plan policy for Afamelanotide (Scenesse) but does not expose the policy text, coverage criteria, or authorization requirements.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyAficamten (Myqorzo) Medicaid CoverageThe supplied document appears to be a UPMC Health Plan Medicaid policy concerning aficamten (Myqorzo), but the policy text and coverage criteria are not available in the provided extract.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyAgalsidase CoverageThe available source identifies a document file named for agalsidase but does not expose the policy text, coverage criteria, authorization requirements, coding information, or clinical conditions governed by the policy.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyAllogeneic regulatory T-cell immunotherapy with HSPC and T cells (Tregzi)This policy appears to address Medicaid coverage of Tregzi, an allogeneic regulatory T-cell immunotherapy involving hematopoietic stem and progenitor cells (HSPC) and T cells.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyAlpelisib (Vijoice) CoverageMedicaid prior authorization policy for alpelisib (Vijoice); clinical coverage requirements are not available in the source text.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyApomorphine subcutaneous infusion (Onapgo)UPMC Health Plan policy concerning apomorphine subcutaneous infusion (Onapgo); coverage requirements, clinical criteria, coding, and authorization rules could not be reviewed because the source PDF was password-protected.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyAvalglucosidase alfa-ngpt (Nexviazyme) – MedicaidThis policy appears to govern Medicaid prior authorization for avalglucosidase alfa-ngpt (Nexviazyme). The available source text contains only document-viewer metadata and does not provide clinical coverage criteria or authorization requirements.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyAxatilimab (Niktimvo) Medicaid CoverageThis document appears to address Medicaid coverage and prior authorization for axatilimab (Niktimvo) under UPMC Health Plan. The available source content contains only document-interface text and does not expose the policy’s clinical criteria or coverage requirements.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyBerdazimer gel (Zelsuvmi)UPMC Health Plan coverage of berdazimer gel (Zelsuvmi); no substantive coverage criteria or authorization rules are present in the available source artifact.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyBeremagene geperpavec-svdt (Vyjuvek) — Medicaid Prior AuthorizationThis policy appears to address Medicaid prior authorization for beremagene geperpavec-svdt (Vyjuvek). The available source content contains only document-interface text and does not provide coverage criteria, authorization requirements, or clinical policy details.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyBirch triterpene topical gel (Filsuvez)UPMC Health Plan Medicaid policy concerning birch triterpene topical gel (Filsuvez); the available source does not provide coverage criteria, authorization requirements, or clinical policy rules.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyBrensocatib (Brinsupri) CoverageThis document appears to be a UPMC Health Plan Medicaid prior-authorization policy for brensocatib (Brinsupri). The available source text contains only document-interface content and does not expose the policy’s clinical coverage criteria or authorization requirements.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyBrexucabtagene autoleucel (Tecartus) Coverage — MedicaidThis policy appears to govern Medicaid prior authorization for brexucabtagene autoleucel (Tecartus) under UPMC Health Plan. The available source does not provide clinical coverage criteria or operational requirements.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyBumetanide (Enbumyst) Medicaid CoverageThis document appears to address Medicaid prior authorization for bumetanide (Enbumyst) under UPMC Health Plan. The available source contains only a protected-PDF interface and does not expose the policy's coverage criteria or operational requirements.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyCHIP IACCV Prior Authorization PoliciesThe available document content identifies a UPMC Health Plan PDF concerning CHIP IACCV prior authorization policies. The substantive policy text, coverage criteria, drug requirements, coding, and clinical rules are not readable in the provided source.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyCHIP Step Therapy PoliciesThe available source contains only PDF viewer interface text and does not expose the underlying policy content. Coverage scope, requirements, and applicability cannot be reliably determined from the available text.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyCaplacizumab-yhdp (Cablivi) coverageThis policy appears to govern Medicaid prior authorization for caplacizumab-yhdp (Cablivi) under UPMC Health Plan. The supplied source contains only PDF viewer and document-access text, so no clinical coverage criteria or provider requirements are available for extraction.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyCasimersen (Amondys 45) CoverageThis document appears to address UPMC Health Plan coverage and prior authorization for casimersen (Amondys 45). No clinical coverage criteria or operational requirements are visible in the supplied source text.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyCiltacabtagene autoleucel (Carvykti)The available source text identifies a UPMC Health Plan Medicaid policy for ciltacabtagene autoleucel (Carvykti), but contains only PDF viewer metadata and no substantive coverage criteria, authorization requirements, or clinical content.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyCipaglucosidase alfa-atga (Pombiliti) coverageThis document appears to govern Medicaid coverage and prior authorization for cipaglucosidase alfa-atga (Pombiliti). The available source does not provide substantive clinical coverage criteria.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyClinical/Medical PolicyThe source document content was not accessible because the PDF was password-protected. No clinical coverage requirements, coding guidance, or applicability details could be extracted.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyCopper Histidinate (Zycubo)This document appears to address coverage of copper histidinate (Zycubo) under a UPMC Health Plan Medicaid policy. The available source text does not provide clinical coverage criteria or authorization requirements.All UPMC Health Plan updates
- Coverage CriteriaClinical/Medical PolicyCough and Cold Medications in Children and AdolescentsThis policy concerns cough and cold medications for children and adolescents under UPMC Health Plan Medicaid managed care. The available source extract does not expose the policy's coverage criteria or authorization requirements.All UPMC Health Plan updates
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Tool Description
Search UPMC Health Plan 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.
FAQ
Coverage criteria are the specific clinical requirements a payer sets for covering a drug, procedure, or service: diagnoses, symptom duration, prior treatments tried, age limits, and documentation. They are published inside medical policies and clinical criteria documents, and a claim or authorization that does not meet them is denied as not medically necessary.
Coverage Criteria by Payer
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