Agency For Health Care Administration Prior Authorization Lookup
- Agency For Health Care Administration timely filing
- Agency For Health Care Administration coverage criteria
- All Agency For Health Care Administration policy updates
Latest Agency For Health Care Administration prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-07-01SUNOSI (solriamfetol) Coverage CriteriaPrior authorization for SUNOSI (solriamfetol) in adults with narcolepsy or obstructive sleep apnea and associated excessive daytime sleepiness, including initial authorization, continuation, documentation, dosing, and authorization duration requirements.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyEff. 2025-07-09Anti-Migraine CriteriaThis policy governs prior authorization for Nurtec ODT, Qulipta, and Ubrelvy for adult Medicaid beneficiaries, including initial therapy, continuation therapy, prior-trial, documentation, and dosing requirements.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyABECMA (idecabtagene vicleucel) Coverage and Prior AuthorizationThis policy governs prior authorization and administration of ABECMA (idecabtagene vicleucel) for adults with relapsed or refractory multiple myeloma in hospital inpatient or outpatient settings.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyANTIPSYCHOTIC POLYPHARMACY CRITERIAThis policy establishes prior authorization criteria for antipsychotic polypharmacy for members with schizophrenia spectrum disorders or bipolar disorder with psychosis and/or severe symptoms. It governs initial approval, continuation of therapy, and a six-month authorization period.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyARIKAYCE Prior Authorization CriteriaPrior authorization coverage criteria for ARIKAYCE (amikacin liposome inhalation suspension) in adults with refractory Mycobacterium avium complex lung disease.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyAbilify MyCite Prior Authorization CriteriaThis policy governs prior authorization for Abilify MyCite for eligible Florida Medicaid fee-for-service members and establishes clinical criteria, documentation requirements, alternate approval criteria, and a three-month authorization period.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyAccrufer (ferric maltol) Prior Authorization CriteriaThis policy governs prior authorization for Accrufer capsules for adults with iron deficiency anemia associated with inflammatory bowel disease or non-dialysis-dependent chronic kidney disease. It establishes initial authorization, continuation, documentation, laboratory, and oral iron trial requirements.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyAdakveo (crizanlizumab-tmca) Prior Authorization CriteriaThis policy governs prior authorization and continuation of Adakveo (crizanlizumab-tmca) for patients with sickle cell disease. It applies to requests for patients age 16 or older and establishes clinical eligibility, specialist prescribing, response, dosing, and authorization-duration requirements.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyAdbry (tralokinumab-ldrm) Prior Authorization Criteria for Moderate-to-Severe Atopic DermatitisThis policy governs Medicaid fee-for-service prior authorization and continuation criteria for Adbry (tralokinumab-ldrm) in patients with moderate-to-severe atopic dermatitis. It applies to providers requesting initial or continued treatment.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyAemcolo (rifamycin) Prior Authorization CriteriaEstablishes prior authorization criteria for Aemcolo (rifamycin) in adults with travelers' diarrhea caused by non-invasive Escherichia coli, including clinical eligibility, contraindications, coverage approval, and authorization duration.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyAlyftrek Prior Authorization CriteriaThis policy establishes prior authorization requirements for Alyftrek (vanzacaftor/tezacaftor/deutivacaftor) for patients with cystic fibrosis, including initial and continuation therapy criteria, genetic confirmation, safety monitoring, specialist involvement, treatment response, and authorization duration.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyAmlodipine (Norliqva and Katerzia) Oral Solution/Suspension Coverage CriteriaThis policy governs prior authorization for Norliqva (amlodipine) oral solution and Katerzia (amlodipine) oral suspension for patients age 6 years or older with hypertension or specified coronary artery disease indications, subject to preferred-agent trial requirements and continuation criteria.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyArbli (losartan potassium) Prior Authorization CriteriaThis policy governs Medicaid fee-for-service prior authorization for Arbli (losartan potassium), including initial approval and continuation of therapy. It applies to providers requesting coverage for eligible patients with specified hypertension-related or diabetic nephropathy indications.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyBREYANZI (lisocabtagene maraleucel) Coverage CriteriaThis policy governs prior authorization for BREYANZI (lisocabtagene maraleucel) for adult patients with specified large B-cell lymphomas. It establishes eligibility criteria, authorization duration, dosing information, and administration through a REMS-certified healthcare facility.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyBenlysta (belimumab) Prior Authorization CriteriaThis policy governs prior authorization for Benlysta (belimumab) for active, autoantibody-positive systemic lupus erythematosus and active lupus nephritis, and applies to providers requesting coverage through the Agency for Health Care Administration.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyBile Salts AgentsThis policy governs Medicaid fee-for-service prior authorization for preferred and non-preferred bile salts agents, including product-specific clinical criteria, documentation, laboratory monitoring, and authorization duration.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyBkemv, Epysqli, and Soliris Prior Authorization CriteriaThis pharmacy policy governs prior authorization and continuation criteria for Bkemv, Epysqli, and Soliris used for paroxysmal nocturnal hemoglobinuria, atypical hemolytic uremic syndrome, generalized myasthenia gravis, and, for Soliris only, neuromyelitis optica spectrum disorder. It applies to providers requesting coverage through the Agency for Health Care Administration.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyBonsity (teriparatide)/Forteo (teriparatide) Injection Prior Authorization CriteriaThis policy governs prior authorization for Bonsity (teriparatide) and Forteo (teriparatide) injection for adults with osteoporosis at high risk for fracture. It applies to providers requesting initiation or continuation of therapy under the Agency for Health Care Administration pharmacy policy.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyBrexafemme (ibrexafungerp) Coverage CriteriaThis pharmacy policy establishes prior authorization criteria for Brexafemme (ibrexafungerp) for post-menarchal females at least 12 years of age with vulvovaginal candidiasis. Authorization is provided per prescription when the specified pregnancy-testing and fluconazole trial requirements are met.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyBrineura (cerliponase alfa) Prior Authorization CriteriaThis policy establishes prior authorization criteria for Brineura for patients with late infantile neuronal ceroid lipofuscinosis type 2 (CLN2/TPP1 deficiency), including initial and continuation therapy requirements.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyBrinsupri (brensocatib) Coverage CriteriaThis policy governs prior authorization for Brinsupri (brensocatib) tablets for Medicaid beneficiaries with non-cystic fibrosis bronchiectasis, including initial and continuation therapy criteria, authorization durations, and dosing information.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyBronchitol (mannitol) Prior Authorization CriteriaThis pharmacy policy governs prior authorization and continuation of Bronchitol (mannitol) inhalation powder for adults with cystic fibrosis. It establishes clinical eligibility, prerequisite therapy documentation, tolerance testing, dosing, and authorization duration.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyButalbital-Containing ProductsThis policy governs prior authorization requests for quantities of butalbital-containing products that exceed the existing quantity limitation. It applies to providers requesting coverage for patients with chronic tension-type or migraine headaches who meet specified specialty consultation and treatment-failure criteria.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyCONCOMITANT THERAPY DRUG CRITERIAThis policy establishes prior authorization criteria for concurrent use of specified sedative, stimulant, benzodiazepine, and long-acting opioid therapies. It governs initial and continued authorization based on prescriber awareness, medical necessity, clinical response, safety monitoring, and FDA-approved dosing.All Agency for Health Care Administration updates
- Prior AuthClinical/Medical PolicyCamzyos (mavacamten) Coverage CriteriaThis policy governs prior authorization and continuation criteria for Camzyos (mavacamten) in adults with symptomatic obstructive hypertrophic cardiomyopathy and requires participation in the Camzyos REMS program.All Agency for Health Care Administration updates
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Tool Description
Search Agency For Health Care Administrationprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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