Careoregon Prior Authorization Lookup
Latest Careoregon prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Dupixent (dupilumab) prior authorizationPrior authorization criteria and reauthorization requirements for Dupixent (dupilumab) for multiple diagnoses including allergic fungal rhinosinusitis, atopic dermatitis, asthma, bullous pemphigoid, chronic rhinosinusitis with nasal polyps, and chronic spontaneous urticaria for CareOregon members.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-26Pharmacy & Specialty Drugs — Coverage Criteria (Abilify Mycite and listed specialty drug prior authorization criteria)This policy lists prior authorization criteria and coverage requirements for Abilify Mycite (Maintenance and Starter Kits) and multiple specialty pharmacy products; it specifies required documentation, prerequisite therapy, prescriber restrictions, initial and renewal coverage durations, and exclusions for CareOregon members.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-22Prior authorization guideline — Liraglutide (generic)Prior authorization guideline for liraglutide (generic) covering multiple indications including type 2 diabetes, chronic kidney disease, and diabetes with obstructive sleep apnea for CareOregon Medicaid members.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-21Adalimumab biosimilars prior authorizationPrior authorization criteria for adalimumab biosimilars (Hadlima, Adalimumab-bwwd, Simlandi, Yusimry, brand adalimumab) across multiple indications for CareOregon members; defines initial and reauthorization requirements and prescriber specialties.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-21Diabetic GLP-1 Agonists (Weekly) — Prior Authorization GuidelinePrior authorization requirements for weekly GLP-1 receptor agonists for treatment of diabetes (products listed include Exenatide, Mounjaro, Trulicity, Ozempic) affecting CareOregon members on the referenced formulary.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Actimmune (interferon gamma-1b) prior authorization for specific diagnosesThis guideline governs prior authorization requirements for the medication Actimmune (interferon gamma-1b) for members requiring therapy for certain specified diagnoses (e.g., Chronic Granulomatous Disease, Malignant osteopetrosis) under CareOregon.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Adbry (tralokinumab-ldrm) prior authorization for atopic dermatitisThis guideline defines prior authorization criteria for initial and reauthorization coverage of Adbry (tralokinumab-ldrm) for members with chronic moderate to severe atopic dermatitis, primarily affecting CareOregon members including Oregon Health Plan considerations.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Adempas (riociguat) prior authorizationThis policy governs prior authorization requirements for Adempas (riociguat) for members of CareOregon; it specifies approval length and clinical criteria for use in pulmonary arterial hypertension (WHO Group 1).All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Advair HFA (fluticasone-salmeterol) prior authorizationDefines prior authorization approval criteria for Advair HFA (fluticasone-salmeterol) for affected CareOregon members beginning 2026-07-01. Applies to medical/pharmacy benefit requests requiring prior authorization.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Allergy immunotherapy (sublingual allergen extracts) coverage criteriaPrior authorization guideline for specific FDA‑approved allergen immunotherapy products (Grastek, Odactra, Oralair, Ragwitek) governing initial authorization and reauthorization criteria for CareOregon members.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Andembry (garadacimab) — Prior Authorization GuidelinePrior authorization guideline for Andembry (garadacimab) for treatment of hereditary angioedema (HAE), covering initial and reauthorization clinical criteria and approval length. Applies to CareOregon-managed members requiring this specialty drug.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Antiandrogens / Androgen Blockers prior authorizationPrior authorization guideline for antiandrogen androgen-blocking drugs (Erleada, Nubeqa, Xtandi, Yonsa) governing initial and reauthorization approvals for members when prescribed and supervised by an oncologist.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Attruby (acoramidis) prior authorization for transthyretin-mediated amyloid cardiomyopathyPrior authorization criteria for initiation and reauthorization of Attruby (acoramidis) for adults with transthyretin-mediated amyloid cardiomyopathy (ATTR-CM). Applies to providers requesting coverage through CareOregon.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Ayvakit (avapritinib) prior authorizationPrior authorization guideline for Ayvakit (avapritinib) for oncology indications (GIST and systemic mastocytosis) describing initial and reauthorization criteria and approval lengths for CareOregon members.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Azole Antifungals (itraconazole, voriconazole, posaconazole) — Prior AuthorizationDefines prior authorization requirements for azole antifungal agents (itraconazole, voriconazole, posaconazole and related formulations) for CareOregon members, including indication, specialist initiation, prior trial/contraindication logic, and liquid formulation criteria.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Aztreonam inhalation (Cayston) prior authorizationThis document defines CareOregon's prior authorization criteria for inhaled aztreonam (Cayston) for members, including initial and reauthorization requirements and required clinical documentation.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Benlysta (belimumab) prior authorization for SLE and biopsy‑proven lupus nephritisPrior authorization criteria for use of belimumab (Benlysta) for systemic lupus erythematosus (SLE) and biopsy‑proven lupus nephritis, covering initial and reauthorization requirements and prescriber qualifications for CareOregon members.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Benznidazole prior authorization for Chagas diseaseThis policy governs prior authorization requirements for benznidazole when used to treat Chagas disease for CareOregon members; it specifies diagnostic confirmation and prescriber specialty requirements and approval length.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Besremi (ropeginterferon alfa-2b) — Prior AuthorizationDefines prior authorization requirements for Besremi (ropeginterferon alfa-2b) for treatment of high-risk polycythemia vera, including initial authorization and reauthorization criteria and approval length.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Bimatoprost 0.03% ophthalmic solution prior authorizationPrior authorization guideline for coverage and step-therapy requirements for bimatoprost 0.03% ophthalmic solution for CareOregon members.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Brinsupri (brensocatib) prior authorizationPrior authorization requirements for prescribing Brinsupri (brensocatib) for pulmonary indications, including initial and reauthorization criteria; applies to providers submitting requests to CareOregon.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Camzyos (mavacamten) prior authorizationPrior authorization requirements for initiating and renewing Camzyos (mavacamten) for members with obstructive hypertrophic cardiomyopathy; applies to providers submitting requests to CareOregon.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Ciprofloxacin/Dexamethasone Otic prior authorizationPrior authorization requirements for ciprofloxacin/dexamethasone otic (ear drops) for members under CareOregon Medicaid, specifying approved indications and required prior therapies.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Complement C5 Inhibitors (Zilbrysq) — Prior Authorization GuidelinePrior authorization guideline for coverage of the complement C5 inhibitor Zilbrysq for adults with anti‑AChR antibody–positive generalized myasthenia gravis (gMG); applies to providers requesting pharmacy benefit approval from CareOregon.All careoregon updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Continuous Glucose Monitor (Freestyle Libre) prior authorizationThis guideline defines prior authorization requirements for Freestyle Libre continuous glucose monitoring (CGM) products for members with diabetes and specifies initial and reauthorization criteria and documentation for CareOregon.All careoregon updates
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Tool Description
Search Careoregonprior 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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