Aspirus Arise Prior Authorization Lookup
Latest Aspirus Arise prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-02-01September 2025 P&T formulary decisions (partial) — Pharmacy & Specialty Drugs coverage criteriaSummarizes Pharmacy & Therapeutics Committee decisions on formulary status, new indications, generics, and dosage-form launches for multiple drugs that affect Aspirus Medicare formulary placement and prior authorization/step therapy rules.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyEff. 2025-06-01Authorization and Notification RequirementsThis document lists services that require prior authorization or notification for Aspirus Health Plan providers and gives procedural, coding, and submission guidance effective June 1, 2025. It applies to providers submitting requests to Aspirus Health Plan (including delegated services where noted).All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyEff. 2024-04-01Reconstructive and Cosmetic Health ServicesDefines medical necessity criteria and coverage stance for reconstructive versus cosmetic surgical and nonsurgical services for Aspirus Health Plan members; applies to providers requesting coverage determinations and prior authorization for reconstructive services.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyEff. 2024-03-15Hematology - Adzynma Utilization Management Medical PolicyDefines prior authorization, coverage criteria, dosing, and documentation requirements for Adzynma for treatment of congenital thrombotic thrombocytopenic purpura for Aspirus Medicare Plans.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyEff. 2023-11-15Adstiladrin (nadofaragene firadenovec) for NMIBC — Oncology (Intravesical) - Adstiladrin UM Medical PolicyCovers prior authorization, coverage criteria, dosing, and approval durations for Adstiladrin intravesical therapy in adults with high-risk BCG-unresponsive non‑muscle invasive bladder cancer; applies to Aspirus Medicare plans and requires specialist prescribing or consultation.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyEff. 2023-11-15Adstiladrin (nadofaragene firadenovec) intravesical therapy — Coverage CriteriaPrior-authorization and coverage criteria for Adstiladrin for adults with high-risk BCG-unresponsive non‑muscle invasive bladder cancer (NMIBC) with CIS with or without papillary tumors, for Aspirus Arise plans.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyEff. 2022-01-01Oncology (Injectable) - Abraxane Utilization Review Medical PolicyMedicare plan coverage and prior authorization criteria for Abraxane (paclitaxel albumin‑bound) for multiple cancer indications; applies to Aspirus Medicare Plans and providers seeking medical benefit coverage.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyEff. 2021-07-01Abecma (idecabtagene vicleucel) CAR‑T therapy coverageDefines prior authorization, coverage criteria, dosing, and exclusions for Abecma (idecabtagene vicleucel) for Aspirus Medicare Plans for treatment of relapsed/refractory multiple myeloma.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyEff. 2021-01-01Aldurazyme (laronidase) — Enzyme Replacement Therapy for MPS IThis policy governs prior authorization and medical necessity criteria for coverage of Aldurazyme (laronidase) for treatment of Mucopolysaccharidosis type I (MPS I) for Aspirus Medicare plans and applies to providers prescribing or requesting authorization.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyEff. 2021-01-01Aliqopa (copanlisib IV) Utilization Management Medical PolicyDefines prior authorization, coverage criteria, dosing, and restrictions for Aliqopa (copanlisib IV) for Aspirus Medicare Plans; applies to providers prescribing or requesting coverage for Aliqopa.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyEff. 2021-01-01Enzyme Replacement Therapy - Aldurazyme (laronidase) Utilization Management Medical PolicyThis policy governs prior authorization, coverage criteria, dosing, and prescribing specialist requirements for Aldurazyme (laronidase) for treatment of Mucopolysaccharidosis type I (MPS I) across Aspirus Medicare Plans and related Aspirus Arise lines.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyEff. 2021-01-01Inflammatory Conditions - Tocilizumab Intravenous Products Utilization ManagementPrior authorization and coverage criteria for intravenous tocilizumab products (Actemra, Avtozma, Tofidence) for Aspirus Medicare Plans, including indication- and dosing-based authorization rules and preferred product step therapy.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyEff. 2021-01-01Inflammatory Conditions - Tocilizumab Intravenous Products Utilization Management Medical PolicyPrior authorization and coverage criteria for intravenous tocilizumab products (Actemra, Avtozma, Tofidence) for Aspirus Medicare Plans; defines indications, dosing, step therapy, and authorization durations for medical benefit coverage.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyEff. 2021-01-01Inflammatory Conditions Tocilizumab Intravenous Products Utilization Management Medical PolicyThis policy governs prior authorization, coverage criteria, dosing, and specialty prescriber requirements for intravenous tocilizumab products (Actemra, Tofidence and listed biosimilars) for Aspirus Medicare plans.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyEff. 2021-01-01Repository Corticotropin (Acthar Gel) — Utilization ManagementDefines prior authorization, coverage criteria, dosing, and non-coverage conditions for Acthar Gel for members of Aspirus Medicare Plans, and directs prescribing by or in consultation with specialists.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyEff. 2021-01-01Sickle Cell Disease - Adakveo (crizanlizumab) Utilization Management Medical PolicyDefines prior authorization and medical necessity criteria for coverage of Adakveo (crizanlizumab-tmca) to reduce vaso-occlusive crises in patients with sickle cell disease for Aspirus Medicare Plans.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyAuthorization and Notification RequirementsDefines prior authorization and notification requirements for inpatient and outpatient services for Aspirus Health Plan providers, including codes, timing, forms, and contact information.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyAuthorization and Notification RequirementsLists services that require prior authorization or notification for Aspirus Health Plan providers, with procedural codes, requirements, and referenced medical necessity criteria. Applies to providers submitting requests for inpatient, outpatient, DME, procedures, diagnostics, and related services.All Aspirus Arise updates
- Prior AuthReimbursement/Payment PolicyDiabetic supplies coverage for Medicare Advantage plansThis document lists covered diabetic supplies (glucose meters, test strips, CGMs, insulin delivery devices, and related supplies) for Aspirus Health Plan Medicare Advantage members and indicates benefit part, acquisition channel, quantity limits, and prior authorization requirements.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyGenetic testing prior authorization criteria and request formThis document is a prior authorization form and criteria checklist for genetic and molecular testing requests submitted to Aspirus Arise. It defines clinical documentation and provider requirements that must be met and submitted to support medical necessity for genetic tests.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyHome health and home infusion pre-certification/authorization form coverage criteriaThis document is a pre-certification and authorization request form used by CARECONTINUUM for home health, home infusion, MDO, or AIC services and applies to providers requesting coverage through Aspirus Arise. It collects patient, clinic, prescriber, and requested drug/service information to support utilization review.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyMedical Injectable Drug (Part B) Authorization ListA payer-maintained list of injectable drugs (Medicare Part B) that typically require prior authorization or step therapy before administration in outpatient/office settings; intended for providers submitting authorization requests to Aspirus Arise/Care Continuum.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyMedical Injectable Drug Authorization ListList of medical injectable drugs typically administered in provider offices that require prior authorization or step therapy under the medical benefit for Aspirus Arise members; applies to providers submitting authorization requests for drugs on this list.All Aspirus Arise updates
- Prior AuthClinical/Medical PolicyMedicare Part D Coverage Determinations and ExceptionsDefines procedures for prior authorization and formulary exception requests for Medicare Part D drugs, who may request them, timelines for decisions, and appeal/representative processes for Aspirus Health Plan Medicare members and their providers.All Aspirus Arise updates
- Prior AuthAdministrative/Operational PolicyNon-emergent fixed wing air ambulance prior authorization request formForm and process for requesting prior authorization for non-emergent fixed-wing air ambulance transport for Aspirus Arise members; applies to ordering practitioners, servicing and receiving providers, and administrative staff submitting requests. Emergent transports do not require prior authorization.All Aspirus Arise updates
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Tool Description
Search Aspirus Ariseprior 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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