ConnectiCare Prior Authorization Lookup
Latest ConnectiCare prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-09-11Autologous Chondrocyte Implantation for Knee Cartilage DefectsThis policy governs ConnectiCare coverage and prior authorization for autologous chondrocyte implantation (ACI), including MACI, to repair symptomatic focal articular cartilage defects of the knee for commercial members, subject to the member’s benefit plan and applicable coverage requirements.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-11Balloon SinuplastyThis policy governs ConnectiCare coverage and prior authorization for balloon sinuplasty, including use with functional endoscopic sinus surgery (FESS) and as a stand-alone procedure. It applies to providers submitting clinical evidence for medical-necessity review; member benefit-plan terms may further limit coverage.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-11Biomagnetic TherapyThis policy governs ConnectiCare coverage and medical-necessity determinations for biomagnetic therapy, including static magnetic field therapy delivered through devices placed on or near the skin. It applies to providers submitting requests for this treatment and requires clinical evidence for prior-authorization review.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-11Cortical Stimulation for Epilepsy (NeuroPace®)ConnectiCare medical-necessity review and prior authorization for cortical responsive neurostimulation for epilepsy, including implantation, replacement, revision, removal, and related device services.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-11Gender-Affirming SurgeryThis policy governs ConnectiCare coverage and prior authorization review for puberty suppression, cross-sex hormone therapy, gender-affirming genital and breast surgery, and related procedures. It applies to members requesting medically necessary treatment for gender dysphoria, subject to the member’s benefit plan and applicable legal requirements.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-12Automatic External DefibrillatorsThis policy governs coverage of wearable and nonwearable automatic external defibrillators for ConnectiCare members with a DME benefit who are at high risk for sudden cardiac death. Coverage requires the applicable clinical criteria and supporting clinical documentation for prior authorization.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-12Continuous Passive Motion DevicesThis policy governs home continuous passive motion device coverage for members with a Durable Medical Equipment benefit, including covered postoperative and infant clubfoot indications, medical necessity limits, prior authorization documentation, and applicable procedure and diagnosis codes. Coverage is subject to the member’s benefit plan and the policy’s clinical criteria.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-11Amyotrophic Lateral Sclerosis (ALS): Edaravone Coverage CriteriaThis policy governs coverage and prior authorization for intravenous and oral edaravone products used to treat amyotrophic lateral sclerosis (ALS), including clinical eligibility, documentation, prescriber, dosing, continuation, and administration requirements.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-11Daybue (trofinetide) for Rett syndromePharmacy coverage and prior authorization for oral Daybue in adults and pediatric members age 2 years and older with typical or classic Rett syndrome, subject to diagnosis, MECP2 mutation, weight, severity, monitoring, and continuation-response requirements.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-11Ebglyss Coverage for Moderate-to-Severe Atopic DermatitisThis policy governs prior authorization and coverage of Ebglyss (lebrikizumab-lbkz) for members 12 years of age and older with moderate-to-severe atopic dermatitis, including clinical eligibility, prescriber, dosing, continuation, administration, and documentation requirements.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-11Leqembi (lecanemab-irmb) Coverage CriteriaThis policy governs prior authorization and coverage criteria for lecanemab-irmb products used to treat Alzheimer's disease in ConnectiCare commercial members, including eligibility, documentation, continuation requirements, dosing, prescriber qualifications, and administration settings.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-11Riluzole (Rilutek/Tiglutik/Exservan)This policy governs prior authorization and coverage criteria for oral riluzole products used to treat amyotrophic lateral sclerosis (ALS) under the pharmacy benefit.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-06Agamree (vamorolone) Coverage for Duchenne Muscular DystrophyPrior authorization coverage for oral Agamree in members with Duchenne muscular dystrophy who are at least 2 years old, including initial and continuation criteria, documentation, dosing, and administration requirements.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-06Eucrisa (crisaborole) Coverage for Atopic DermatitisThis policy governs prior authorization and coverage requirements for Eucrisa (crisaborole) for atopic dermatitis, including diagnosis, prior topical treatment response or intolerance, baseline disease activity, continuation benefit, and quantity limits.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-06Filsuvez Coverage for Epidolysis Bullosa WoundsThis policy governs prior authorization and coverage of Filsuvez (birch triterpenes gel) for adults and pediatric patients with wounds associated with dystrophic or junctional epidermolysis bullosa. It establishes clinical eligibility, documentation, prescriber, quantity, duration, and continuation requirements.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-06Xenazine (tetrabenazine) Coverage CriteriaPrior authorization coverage of tetrabenazine/Xenazine for Huntington disease chorea, moderate-to-severe tardive dyskinesia, and Tourette syndrome, subject to condition-specific documentation, prescriber qualifications, dose limits, and contraindication review.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-30Myalept (metreleptin) Coverage CriteriaPrior authorization coverage for Myalept subcutaneous injection for complications of leptin deficiency in members with congenital or acquired generalized lipodystrophy, including initial and continuation criteria, documentation requirements, dosing limits, and administration setting.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-30Santyl (collagenase) Coverage CriteriaCoverage and prior authorization requirements for topical Santyl (collagenase) used to debride chronic dermal ulcers and severely burned areas under the applicable pharmacy or medical benefit.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-30Tzield (teplizumab-mzwv) Coverage CriteriaThis policy governs prior authorization and coverage of intravenous Tzield (teplizumab-mzwv) to delay the onset of Stage 3 type 1 diabetes in adults and pediatric patients age 8 years and older with Stage 2 type 1 diabetes. It applies to providers requesting coverage under the member's applicable pharmacy or medical benefit.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-22Nuedexta (dextromethorphan/quinidine) Coverage for Pseudobulbar AffectPrior authorization coverage of oral Nuedexta for members with pseudobulbar affect secondary to a neurological condition, including requirements for clinical eligibility, prescriber qualifications, age, documentation, dosing, continuation, and authorization duration.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-08Implantable Cardioverter DefibrillatorsThis policy governs medical necessity and prior authorization for FDA-approved transvenous and subcutaneous implantable cardioverter defibrillators, including adult and pediatric implantation, surveillance, replacement, and related CRT/ICD use. Coverage depends on specified clinical criteria and applicable benefit-plan terms.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-10Breast Reduction MammoplastyConnectiCare coverage and prior authorization for breast reduction mammoplasty and associated reconstructive mastopexy, including medical-necessity documentation, qualifying symptoms, tissue-removal thresholds, photographs, and age- and risk-based mammography.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01Dalvance (dalbavancin) Coverage CriteriaThis policy governs prior authorization and medical-necessity coverage for intravenous Dalvance (dalbavancin) used to treat acute bacterial skin and skin structure infections and adult osteomyelitis. It applies to providers requesting coverage, subject to member benefit eligibility and the clinical criteria in the policy.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01Seysara (sarecycline) for moderate to severe acne vulgarisThis policy governs pharmacy benefit coverage and prior authorization for oral Seysara (sarecycline) in patients age 9 years and older with inflammatory lesions of non-nodular moderate to severe acne vulgaris. Coverage requires documented topical and oral antibiotic treatment failure, serious adverse effects, or contraindications, and is limited to an initial 12-week authorization.All ConnectiCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01Uplizna (inebilizumab-cdon) Coverage for NMOSD, IgG4-RD, and Generalized Myasthenia GravisThis policy governs prior authorization coverage for intravenous Uplizna in adults with neuromyelitis optica spectrum disorder, immunoglobulin G4-related disease, or generalized myasthenia gravis. Coverage requires diagnosis-specific clinical documentation, infection and concomitant-therapy screening, response or disease-activity monitoring, and applicable site-of-care requirements.All ConnectiCare updates
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Tool Description
Search ConnectiCareprior 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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