Baylor_scott_and_white_health_plan Prior Authorization Lookup
- Baylor_scott_and_white_health_plan coverage criteria
- All Baylor_scott_and_white_health_plan policy updates
Latest Baylor_scott_and_white_health_plan prior authorization updates16
- Prior AuthClinical/Medical PolicyEff. 2026-11-01Emapalumab (Gamifant) Coverage CriteriaPrior authorization and medical-necessity review for emapalumab-lzsg (Gamifant) for primary hemophagocytic lymphohistiocytosis and Still's disease-associated HLH/macrophage activation syndrome.All baylor_scott_and_white_health_plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-10-01Beremagene geperpavec-svdt (Vyjuvek) CoverageThis policy governs prior authorization and medical-necessity coverage for topical beremagene geperpavec-svdt (Vyjuvek) in members with dystrophic epidermolysis bullosa (DEB). Unless otherwise indicated, it applies across lines of business, subject to the applicable benefit plan and federal or state requirements.All baylor_scott_and_white_health_plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-10-01Cerliponase alfa (Brineura) CoveragePrior authorization and medical necessity review for cerliponase alfa administered for neuronal ceroid lipofuscinosis type 2 (CLN2), across lines of business subject to applicable benefit plan and federal or state requirements.All baylor_scott_and_white_health_plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-10-01Nirsevimab-alip (Beyfortus) for RSV preventionThis policy governs medical necessity and prior authorization for nirsevimab-alip (Beyfortus) to prevent RSV lower respiratory tract disease in eligible infants and young children during RSV season.All baylor_scott_and_white_health_plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-10-01Nusinersen (Spinraza) CoverageThis policy governs medical-necessity and prior-authorization requirements for nusinersen (Spinraza) used to treat spinal muscular atrophy. It applies across lines of business unless otherwise specified, subject to the member’s benefit plan, applicable Medicare or Medicaid requirements, and federal or state rules.All baylor_scott_and_white_health_plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-10-01Prademagene zamikeracel (Zevaskyn) coveragePrior authorization and medical-necessity coverage for prademagene zamikeracel (Zevaskyn) for wounds associated with recessive dystrophic epidermolysis bullosa.All baylor_scott_and_white_health_plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Etranacogene dezaparvovec (Hemgenix) coverageThis policy governs medical necessity and prior authorization for etranacogene dezaparvovec (Hemgenix) for adults with hemophilia B. It applies across lines of business unless otherwise indicated, subject to the member's benefit plan, applicable Medicare or Medicaid requirements, and federal or state rules.All baylor_scott_and_white_health_plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Lecanemab-irmb (Leqembi) CoverageThis policy governs prior authorization and medical-necessity coverage for lecanemab-irmb used to treat Alzheimer’s disease across lines of business, subject to applicable benefit plan, federal, and state requirements.All baylor_scott_and_white_health_plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Lisocabtagene Maraleucel (Breyanzi®) CoverageThis policy governs medical necessity and prior authorization for lisocabtagene maraleucel (Breyanzi) for eligible hematologic malignancies. It applies across lines of business unless otherwise indicated and requires documentation of universal and indication-specific criteria.All baylor_scott_and_white_health_plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Ciltacabtagene autoleucel (Carvykti) coverageThis prior authorization policy governs coverage of ciltacabtagene autoleucel (Carvykti), a BCMA-directed CAR-T therapy, for eligible adults with relapsed or refractory multiple myeloma. Documentation must demonstrate that all medical necessity, prior-treatment, safety, dosing, and specialist requirements are met.All baylor_scott_and_white_health_plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Idecabtagene vicleucel (Abecma) CoverageThis policy governs prior authorization and medical-necessity review for idecabtagene vicleucel (Abecma), a BCMA-directed CAR-T therapy. It applies across lines of business unless the applicable benefit plan, federal rule, or state rule provides otherwise.All baylor_scott_and_white_health_plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Teplizumab-mzwv (Tzield) for Stage 2 Type 1 DiabetesThis policy governs coverage and prior authorization for teplizumab-mzwv to delay progression from Stage 2 to Stage 3 type 1 diabetes. It applies to providers and members covered under Baylor Scott & White Health Plan, subject to the applicable benefit plan and program-specific requirements.All baylor_scott_and_white_health_plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Valoctocogene roxaparvovec-rvox (Roctavian) CoverageThis prior authorization policy governs coverage of valoctocogene roxaparvovec-rvox (Roctavian), a one-time gene therapy for adults with severe hemophilia A. It applies to members whose requests are reviewed under the applicable benefit plan and requires clinical documentation demonstrating medical necessity.All baylor_scott_and_white_health_plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Vertebroplasty, Kyphoplasty and SacroplastyMedical-necessity review and prior authorization for percutaneous vertebroplasty, balloon-assisted vertebroplasty/kyphoplasty, sacroplasty, and related procedures across lines of business, with plan-specific review pathways.All baylor_scott_and_white_health_plan updates
- Prior AuthClinical/Medical PolicyEff. 2025-08-01Ventricular Assist Devices and Artificial HeartThis policy governs medical necessity and prior authorization for ventricular assist devices, percutaneous and right ventricular assist devices, pediatric VADs, total artificial hearts, and related services. Coverage depends on FDA-approved indications, device type, clinical criteria, applicable Medicare or Medicaid guidance, and the member's benefit plan.All baylor_scott_and_white_health_plan updates
- Prior AuthClinical/Medical PolicyOnasemnogene Abeparvovec (Zolgensma®) CoverageThis policy governs medical necessity and prior authorization for onasemnogene abeparvovec (Zolgensma) for members with spinal muscular atrophy. It applies across lines of business unless the applicable benefit plan, federal requirements, Medicare criteria, or Texas Medicaid guidance governs instead.All baylor_scott_and_white_health_plan updates
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Tool Description
Search Baylor_scott_and_white_health_planprior 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.
Prior Authorization by Payer
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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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