Delaware First Health Prior Authorization Lookup
Latest Delaware First Health prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2025-09-25Clinical Policy: External Diabetic Devices (Omnipod)Policy governs prior authorization and medical necessity criteria for Omnipod insulin delivery systems (Omnipod DASH, Omnipod 5, Omnipod GO) for Delaware First Health Medicaid members and describes initial and continued coverage requirements.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2025-09-25Crisaborole (Eucrisa) topical therapy — Coverage CriteriaDefines medical necessity criteria, prior authorization and continuation requirements for crisaborole (Eucrisa) topical treatment of mild to moderate atopic dermatitis for Delaware First Health members under the referenced policy.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2024-09-17Clinical Policy: Glecaprevir/Pibrentasvir (Mavyret)Clinical coverage policy governing medical necessity criteria, approval duration, and prescribing limitations for Mavyret (glecaprevir/pibrentasvir) for treatment of hepatitis C virus (HCV) in Delaware First Health members (Medicaid line of business). Applies to prescribers requesting prior authorization.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2024-09-16Elbasvir/grazoprevir (Zepatier) coverageDefines medical necessity, prior authorization, and continuation criteria for Zepatier (elbasvir/grazoprevir) for treatment of chronic hepatitis C virus (HCV) infections for Delaware First Health Medicaid members.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2024-05-01SSRI/SNRI Duplicate TherapyPolicy governs coverage for concurrent use of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for Delaware First Health Medicaid members; it states therapeutic duplication is not medically necessary and requires provider documentation for exceptions. Applies to prescribers and prior authorization reviewers for the listed line of business.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2024-05-01SSRI/SNRI Duplicate TherapyPolicy governing therapeutic duplication of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for Delaware First Health Medicaid members; defines coverage stance and documentation requirements for providers requesting concurrent therapy. Applies to medications in those classes and prescribers requesting prior authorization for duplicate therapy.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2023-10-12Enzalutamide (Xtandi) Coverage CriteriaDefines medical necessity and prior authorization criteria for enzalutamide (Xtandi) for prostate cancer indications for Delaware First Health members across Commercial, HIM, and Medicaid lines of business.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2023-09-17Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi) coverageDefines prior authorization, coverage criteria, and treatment conditions for Vosevi (sofosbuvir/velpatasvir/voxilaprevir) for Delaware First Health Medicaid members. Applies to initial and continued therapy, listing required documentation, alternative therapies, and contraindications.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2023-01-23Clinical Policy: Anti-Obesity MedicationsDefines Delaware First Health (Medicaid) coverage, medical necessity criteria, and prior authorization requirements for specified anti-obesity medications for adults and pediatric members, and for indications including weight loss, MASH, and prevention of MACE.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2022-09-16Clinical Policy: Elbasvir/Grazoprevir (Zepatier)Defines medical necessity criteria, prior authorization, and coverage rules for Zepatier (elbasvir/grazoprevir) for treatment of hepatitis C virus (HCV) infection for Delaware First Health (Medicaid); includes dosing by genotype, documentation requirements, step therapy preferences, and an appendix on managing missed therapy.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2022-08-16Etanercept (Enbrel) - Coverage Criteria and Prior AuthorizationClinical coverage and prior authorization criteria for Etanercept (Enbrel) for Delaware First Health Medicaid members, including initial and continuation therapy requirements across FDA‑approved indications.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2022-03-01Diclofenac (Pennsaid) topical solution for osteoarthritis knee painClinical coverage policy governing medical necessity and prior authorization criteria for Pennsaid (diclofenac 2% topical solution) for treatment of osteoarthritis knee pain for members under the payer's Medicaid line of business.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2022-02-01Opioid AnalgesicsDefines medical necessity, prior authorization, and approval criteria for opioid analgesic therapy (short-term, transition to long-term, and continued therapy) for Delaware First Health members (Medicaid line of business). Applies to providers requesting opioid prescriptions and prior authorizations.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2020-07-24Brexucabtagene autoleucel (Tecartus) coverageDefines medical necessity and prior authorization criteria for a single administration of brexucabtagene autoleucel (Tecartus) for adult patients with relapsed/refractory mantle cell lymphoma (MCL) or B-cell precursor acute lymphoblastic leukemia (ALL) across Delaware First Health lines of business.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2020-06-01Clinical Policy: Ubrogepant (Ubrelvy)Policy governs medical necessity and prior authorization criteria for ubrogepant (Ubrelvy) for acute treatment of migraine in adult members under Delaware First Health (Centene-affiliated) Medicaid.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2020-04-22Clinical Policy: Sacituzumab govitecan‑hziy (Trodelvy) coverageDefines medical necessity, prior authorization, and coverage criteria for sacituzumab govitecan‑hziy (Trodelvy) for Delaware First Health lines of business (Commercial, HIM/ICHRA, Medicaid). Applies to providers requesting coverage for the drug.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2020-01-01Clinical Policy: Edoxaban (Savaysa)Defines medical necessity and prior authorization criteria for edoxaban (Savaysa) for Medicaid members, including indications, dosing limits, and documentation requirements for prescribers.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2019-05-07Solriamfetol (Sunosi) coverageDefines medical necessity, prior authorization, and coverage criteria for solriamfetol (Sunosi) for treatment of excessive daytime sleepiness associated with narcolepsy or obstructive sleep apnea for Delaware First Health lines of business.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2018-09-19Dipeptidyl Peptidase-4 (DPP-4) Inhibitors prior authorizationDefines prior authorization, coverage criteria, and continuation requirements for DPP-4 inhibitor medications for adults with type 2 diabetes mellitus under Delaware First Health (Medicaid). Applies to provider requests for listed DPP-4 products and certain combination products.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2018-06-01Apalutamide (Erleada) — Coverage CriteriaDefines medical necessity, prior authorization, and continuation criteria for apalutamide (Erleada) for Delaware First Health Medicaid members, including FDA-approved and select off‑label prostate cancer uses, and prescribing/step therapy expectations for providers.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2018-01-30Tofacitinib (Xeljanz, Xeljanz XR) coverageDefines medical necessity, prior authorization, and continuation criteria for tofacitinib (Xeljanz and Xeljanz XR) for Delaware First Health (Medicaid) members across approved indications. Affects prescribers and PA reviewers handling tofacitinib requests.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2017-09-01Rucaparib (Rubraca) coverageDefines medical necessity and prior authorization criteria for rucaparib (Rubraca) for commercial, HIM, and Medicaid lines of business within Delaware First Health; covers FDA-approved and select NCCN-recommended off-label indications and continuation criteria.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2017-07-01Valbenazine (Ingrezza, Ingrezza Sprinkle) coverageClinical coverage and prior authorization criteria for valbenazine (Ingrezza, Ingrezza Sprinkle) for treatment of tardive dyskinesia and chorea associated with Huntington disease for Delaware First Health lines of business.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2017-06-13Deutetrabenazine (Austedo, Austedo XR) coverageDefines medical necessity, prior authorization, and continuation criteria for deutetrabenazine (Austedo/Austedo XR) for Delaware First Health (Medicaid line of business). Applies to providers requesting coverage for members under the referenced plan.All Delaware First Health updates
- Prior AuthClinical/Medical PolicyEff. 2017-03-01Rivastigmine (Exelon) prior authorization and coverage criteriaDefines medical necessity criteria, dosing limits, and prior authorization requirements for rivastigmine (Exelon) products for Delaware First Health Medicaid members, including Alzheimer’s disease and Parkinson's disease dementia.All Delaware First Health updates
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Tool Description
Search Delaware First Healthprior 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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