Countycare Prior Authorization Lookup
Latest Countycare prior authorization updates13
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Adakveo (crizanlizumab-tmca) Coverage Criteria for Sickle Cell DiseaseThis policy governs prior authorization under the CountyCare medical benefit for Adakveo in practitioners treating members with sickle cell disease. It establishes initial approval and annual reauthorization requirements for members age 16 or older.All countycare updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Enjaymo (sutimlimab-jome) Coverage CriteriaThis policy governs prior authorization for Enjaymo under the Health Plan medical benefit for adults with primary cold agglutinin disease. It applies to practitioners requesting or providing the drug and establishes initial and annual continuation criteria.All countycare updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Evkeeza (evinacumab-dgnb) Coverage CriteriaThis policy governs prior authorization under the Health Plan medical benefit for Evkeeza in adult and pediatric patients with homozygous familial hypercholesterolemia. It applies to practitioners involved in providing the requested drug and establishes initial and annual reauthorization requirements.All countycare updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Skin Substitutes for Wound ManagementThis policy governs medical-necessity review and prior authorization for skin substitutes used as adjunctive treatment for chronic, hard-to-heal wounds and other specified skin-loss conditions. It applies to CountyCare providers and members receiving covered medical services.All countycare updates
- Prior AuthClinical/Medical PolicyEff. 2026-03-01Duchenne Muscular Dystrophy Drug TherapiesThis guideline governs prior authorization under the Health Plan medical benefit for Amondys 45, Vyondys 53, and Elevidys used to treat Duchenne muscular dystrophy. It applies to practitioners involved in providing the requested drugs.All countycare updates
- Prior AuthClinical/Medical PolicyEff. 2026-03-01Ryoncil (remestemcel-L-rknd) Coverage CriteriaThis guideline governs prior authorization for Ryoncil under the Health Plan's medical benefit for eligible pediatric members with acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation.All countycare updates
- Prior AuthClinical/Medical PolicyEff. 2026-03-01Tepezza (teprotumumab-trbw) Prior Authorization for Thyroid Eye DiseaseThis guideline governs prior authorization for Tepezza under the Health Plan medical benefit for Medicaid members and establishes initial authorization criteria, dosing, documentation, and infusion limits.All countycare updates
- Prior AuthClinical/Medical PolicyEff. 2026-03-01Vyepti (eptinezumab-jjmr) Coverage for Chronic Migraine PreventionThis guideline governs prior authorization for Vyepti under the Health Plan medical benefit for Medicaid members and establishes initial authorization, reauthorization, dosing, documentation, and coding requirements.All countycare updates
- Prior AuthClinical/Medical PolicyEff. 2025-10-01Natalizumab ProductsThis guideline governs prior authorization for Tysabri (natalizumab) and Tyruko (natalizumab-sztn) under the Health Plan's medical benefit. It applies to practitioners requesting these products for adult Medicaid members with Crohn's disease or relapsing multiple sclerosis.All countycare updates
- Prior AuthClinical/Medical PolicyEff. 2025-08-01Nulojix (belatacept) prior authorization for kidney transplantThis guideline governs prior authorization and reauthorization for Nulojix (belatacept) under the Health Plan's medical benefit for adult members undergoing or having undergone renal transplantation.All countycare updates
- Prior AuthClinical/Medical PolicyAlpha1 Proteinase InhibitorsThis guideline governs prior authorization for alpha1 proteinase inhibitors provided under the health plan's medical benefit and applies to practitioners providing the requested drug for Medicaid members.All countycare updates
- Prior AuthClinical/Medical PolicyVisudyne (verteporfin) Prior AuthorizationThis policy governs prior authorization for verteporfin (Visudyne) used for specified forms of subfoveal choroidal neovascularization. It applies to CountyCare members whose providers request initial authorization or annual continuation of therapy.All countycare updates
- Prior AuthClinical/Medical PolicyZynteglo (betibeglogene autotemcel)This policy governs prior authorization and medical-necessity review for Zynteglo in adult and pediatric members with β-thalassemia who require regular red blood cell transfusions. Approval requires specialist prescribing, age, diagnostic, transfusion-dependence, laboratory, imaging, and safety criteria.All countycare updates
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Tool Description
Search Countycareprior 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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