Allcareadvantage Prior Authorization Lookup
Latest Allcareadvantage prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-06-10Approval Criteria for Biologic and Immune ModulatorsDefines prior authorization, coverage, and renewal criteria for FDA‑approved biologic and immune‑modulator therapies for autoimmune and inflammatory diseases for AllCare Advantage members; applies to prescribers requesting coverage of these agents.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-02Approval criteria for Non-preferred inhalers and/or regimensDefines prior authorization and approval criteria for coverage of non-preferred inhaler products and inhaler regimens for members with asthma, reactive airways disease (RAD), or COPD who are established on a reliever (e.g., albuterol). Applies to AllCare Advantage members.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Approval Criteria for formulary SGLT2 InhibitorsDefines AllCare Advantage coverage, prior authorization, and renewal criteria for formulary and non-formulary SGLT2 inhibitor drugs for treatment of type 2 diabetes, including special considerations for heart failure and chronic kidney disease.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Physician-Administered Drugs Prior AuthorizationDefines prior authorization criteria and process for coverage of physician- or clinician-administered drugs and biologics for AllCare Advantage members; applies to drugs given by a healthcare professional in outpatient clinical settings.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2025-12-18Non-cystic fibrosis bronchiectasis agents (brensocatib)Prior authorization criteria for formulary non-cystic fibrosis bronchiectasis agents (specifically brensocatib/Brinsupri) for AllCare Advantage members; governs coverage decisions for prescribers and pharmacy benefit staff.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2025-09-25Topical Janus Kinase InhibitorsDefines prior authorization and coverage criteria for topical JAK inhibitor therapies (delgocitinib, ruxolitinib) for treatment of chronic hand eczema in adult AllCare Advantage members.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2025-06-26Nonpreferred Urinary Antibiotics Prior AuthorizationDefines prior authorization criteria for covering nonpreferred urinary antibiotic agents (gepotidacin, pivmecillinam, sulopenem etzadroxil-probenecid) for treatment of uncomplicated urinary tract infections; applies to AllCare Advantage members and prescribing providers seeking coverage.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2025-06-26Renin-Angiotensin System - other agents (sparsentan, atrasentan)Prior authorization policy for coverage of renin-angiotensin system - other agents (Filspari/sparsentan and Vanrafia/atrasentan) for adults with primary IgA nephropathy (IgAN) at risk; governs prescribers, renal specialists, and payer reviewers for AllCare Advantage members.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2025-03-31Anti-VEGF antibodies (intravitreal) prior authorizationDefines prior authorization, coverage criteria, and renewal requirements for intravitreal anti-VEGF antibody agents for retinal diseases for AllCare Advantage members.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2025-03-28Dipeptidyl peptidase-4 (DPP-4) inhibitors prior authorizationDefines prior authorization coverage rules for non-preferred and non-formulary dipeptidyl peptidase-4 (DPP-4) inhibitors for members with type 2 diabetes mellitus, including combination agents containing metformin and DPP-4 inhibitors.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2024-11-20Approval criteria for GLP-1 receptor agonistsDefines coverage, prior authorization, renewal, quantity limits, and clinical requirements for formulary and non-formulary GLP-1 receptor agonists for treatment of type 2 diabetes mellitus for AllCare Advantage members.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2024-09-19Drug Specific: sofpironium bromide (Sofdra)Defines AllCare Advantage coverage and prior authorization criteria for sofpironium bromide (Sofdra) for members with primary axillary hyperhidrosis, including initial and renewal requirements, approval lengths, and quantity limits.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2024-09-19Ensifentrine (Ohtuvayre) — Coverage Criteria for Maintenance Treatment of COPDPrior authorization and coverage criteria for ensifentrine (Ohtuvayre) as maintenance treatment for adult patients with COPD under AllCare Advantage.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2024-06-26Linezolid (Zyvox) prior authorizationDefines prior authorization requirements and coverage criteria for the antibiotic linezolid (Zyvox) for AllCare Advantage members, including indications, documentation, and renewal rules for treatment of MRSA and VRE infections.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2024-03-14Prior authorization criteria for vonoprazan (Potassium-competitive acid blocker)Defines prior authorization criteria for coverage of the potassium-competitive acid blocker vonoprazan (Voquezna) for AllCare Advantage / AllCare CCO members, including indications for erosive esophagitis and H. pylori treatment, and renewal conditions.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2024-02-12Approval criteria for 5-ASA agentsDefines prior authorization, coverage, quantity limits, and renewal criteria for 5-aminosalicylic acid (5-ASA) agents for treatment and maintenance of ulcerative colitis or Crohn's disease for AllCare Advantage members.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2023-12-14Prior authorization criteria for anifrolumab (Saphnelo) for systemic lupus erythematosusPrior authorization criteria for coverage of anifrolumab (Saphnelo) for adults with moderate to severe systemic lupus erythematosus when used with standard therapy; applies to AllCare Advantage / AllCare CCO members.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2023-11-15Fall Prevention Benefit (in-home assessment and bathroom safety DME)Defines coverage, prior authorization, and eligibility for an in-home safety assessment and associated bathroom safety durable medical equipment for AllCare Advantage members.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2023-11-01Demodex blepharitis agents (lotilaner/Xdemvy) - Prior Authorization CriteriaDefines prior authorization and coverage criteria for lotilaner ophthalmic solution (Xdemvy) for treatment of Demodex blepharitis for AllCare Advantage members.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2023-09-21Kinase inhibitors for alopeciaDefines prior authorization and coverage criteria for kinase inhibitor medications (baricitinib/Olumiant and ritlecitinib/Litfulo) used to treat severe alopecia areata for AllCare Advantage members.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2023-06-22Calcitonin gene-related peptide (CGRP) receptor agentsDefines prior authorization criteria for coverage of formulary calcitonin gene-related peptide (CGRP) receptor agents for prevention and acute treatment of migraine for AllCare Advantage members.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2023-06-07Pediatric obesity — Pharmacotherapy prior authorizationGoverns prior authorization and coverage criteria for formulary FDA‑approved medications for pediatric weight loss for AllCare Advantage members up to age 20, including approval and renewal requirements.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2023-06-02Anti‑Alzheimer Agents prior authorizationDefines prior authorization, coverage criteria, and renewal requirements for anti‑Alzheimer agents (FDA‑approved treatment of Alzheimer's disease) for AllCare Advantage members aged ≥18. Applies to coverage determinations and documentation required for approval and renewal.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2023-03-23Transdermal stimulants prior authorizationDefines prior authorization requirements for coverage of transdermal stimulant products (e.g., Daytrana, Xelstrym) for treatment of ADHD in members, including approval and renewal criteria and quantity limits.All allcareadvantage updates
- Prior AuthClinical/Medical PolicyEff. 2022-08-25tapinarof (Vtama) topical cream — prior authorization and renewal criteriaDefines prior authorization and renewal criteria for tapinarof 1% cream (Vtama) for treatment of plaque psoriasis in adults for AllCare Advantage members.All allcareadvantage updates
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Tool Description
Search Allcareadvantageprior 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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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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