HealthPartners Prior Authorization Lookup
Latest HealthPartners prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-06-012026 Medicare Part D Prior Authorization Requirements — Specialty & Part D DrugsDefines prior authorization, coverage criteria, exclusions, prescriber and duration rules for Medicare Part D prescription drugs on the HealthPartners formulary; affects prescribers and pharmacists submitting Part D PA requests for affected products.All HealthPartners updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-012026 Medicare Part D Prior Authorization Requirements — Part D formulary coverage criteriaLists prior authorization requirements, criteria, and coverage details for multiple prescription drugs on the HealthPartners 2026 Medicare Part D formulary; applies to Part D benefits and prescribers/providers submitting PA requests.All HealthPartners updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01HSA Plus 2026 Formulary (Drug List)This document is the HealthPartners HSA Plus 2026 formulary listing covered medications, tier assignments, and special program flags (e.g., PA, ST, QL) that govern pharmacy coverage and prior authorization/limit requirements for members and providers.All HealthPartners updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01HealthPartners Formulary — Drug List and Coverage Rules (Pharmacy & Specialty Drugs)Governs the HealthPartners covered drug list (formulary), tiering, and common utilization management programs (prior authorization, step therapy, age limits, quantity limits, specialty pharmacy) for HealthPartners members and providers.All HealthPartners updates
- Prior AuthClinical/Medical PolicyEff. 2026-03-012026 Medicare Part D Prior Authorization Requirements — Part D prior authorization and coverage criteriaRules governing prior authorization, coverage criteria, exclusions, and required documentation for multiple Part D drugs on the HealthPartners Part D formulary effective March 1, 2026; applies to Medicare Part D claims under HealthPartners.All HealthPartners updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-18List of Covered Drugs (Drug List) — HealthPartners MSHODefines which prescription, over-the-counter, and non-drug products are covered by HealthPartners MSHO, explains member rights and administrative rules (prior authorization, quantity limits, step therapy, exceptions, transitions) and who to contact for assistance. Applies to HealthPartners MSHO members.All HealthPartners updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-01HealthPartners Formulary (2026)Governs the HealthPartners 2026 drug formulary, describing covered medicines, pharmacy benefit rules (prior authorization, step therapy, quantity limits, age limits), specialty drug handling, and usage guidance for plan members and providers.All HealthPartners updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-012026 Formulary (Drug List) — Pharmacy Coverage CriteriaGoverns the HealthPartners pharmacy drug list (formulary) effective January 1, 2026; informs members and providers about covered medicines, tiers, specialty designations, limits, and prior authorization/step-therapy programs.All HealthPartners updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-012026 Medicare Part D Prior Authorization Requirements (selected drugs)Portion of a HealthPartners policy listing Medicare Part D prior authorization requirements for specific specialty and pharmacy drugs, including clinical prerequisites, exclusions, prescriber and coverage duration rules for affected products.All HealthPartners updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01HealthPartners Formulary (2026 Drug List) — Coverage & Utilization ControlsThis document is the HealthPartners 2026 formulary drug list and explanatory guide describing how medicines are categorized, coverage rules (e.g., prior authorization, step therapy, quantity limits), and benefit details for members and providers.All HealthPartners updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01HealthPartners HSA Plus 2026 Formulary (drug list and benefit rules)This document is the 2026 HealthPartners HSA Plus formulary describing covered medicines, tiers, specialty drug rules, and common program edits (prior authorization, step therapy, quantity/age limits) for members and providers.All HealthPartners updates
- Prior AuthAdministrative/Operational PolicyEff. 2020-09-20Authorization for Medical-Dental Procedures - Accidental DentalThis form and policy govern prior authorization requests for medical or dental procedures related to accidental dental injuries for HealthPartners members; it affects providers submitting authorization requests and Utilization Management reviewers.All HealthPartners updates
- Prior AuthClinical/Medical PolicyEff. 2020-09-20Authorization for Sacroiliac (SI) joint injectionsThis document governs prior authorization submission requirements for sacroiliac (SI) joint injections for HealthPartners members and describes information providers must supply when requesting authorization.All HealthPartners updates
- Prior AuthAdministrative/Operational PolicyEff. 2020-09-20Prior Authorization for Site of Service Attended Polysomnography for Evaluation of OSAThis document governs prior authorization requests and required form information for site-of-service attended polysomnography (sleep study) for evaluation of OSA for HealthPartners members. It affects ordering clinicians, facilities, and sleep specialists submitting authorization requests.All HealthPartners updates
- Prior AuthAdministrative/Operational PolicyEff. 2020-09-20Prior authorization for attended polysomnography (in‑lab sleep study)This document is a prior authorization request form/process for attended polysomnography to evaluate obstructive sleep apnea (OSA) and other sleep disorders for HealthPartners members; it affects ordering providers, facilities, and members requiring in-lab sleep testing.All HealthPartners updates
- Prior AuthClinical/Medical PolicyACA Preventive Medications — Coverage Criteria (Commercial Plans)Defines which medications HealthPartners classifies as ACA preventive medications for Commercial Plans, notes coverage may be subject to plan rules (prior authorization, step therapy, quantity limits), and applies to prescriptions filled at in-network pharmacies.All HealthPartners updates
- Prior AuthAdministrative/Operational PolicyAuthorization for Fixed Wing Air Ambulance TransportationForms and prior authorization process for fixed-wing air ambulance transport for HealthPartners members; governs requests submitted by providers, facilities, or transportation vendors to Utilization Management.All HealthPartners updates
- Prior AuthClinical/Medical PolicyCardiology, Musculoskeletal and Advanced Imaging Services Prior Authorization ListLists services and CPT/HCPCS codes that require prior authorization through Cohere Health for specified HealthPartners plans and provides guidance on Medicare coverage references for cardiology, musculoskeletal, and advanced imaging procedures.All HealthPartners updates
- Prior AuthClinical/Medical PolicyCardiology, Musculoskeletal and Advanced Imaging Services Prior Authorization List of ServicesDefines which cardiology, musculoskeletal/orthopedic and advanced imaging services require prior authorization through Cohere Health (and sometimes HealthPartners) for specified HealthPartners plans; intended for providers and administrative staff submitting authorizations.All HealthPartners updates
- Prior AuthClinical/Medical PolicyCommercial Formulary Prior Authorization and Step Therapy Coverage CriteriaDefines HealthPartners commercial pharmacy prior authorization (PA) and step therapy (ST) requirements for medications on the 2026 formulary; applies to prescribers and members under the HealthPartners commercial pharmacy benefit.All HealthPartners updates
- Prior AuthClinical/Medical PolicyCommercial Formulary Prior Authorization and Step Therapy Coverage Criteria — Pharmacy & Specialty DrugsThis document lists HealthPartners' commercial drug-list prior authorization (PA) and step therapy (ST) criteria for pharmacy and specialty drugs, explaining when PA/ST is required and linking to specific drug criteria. It affects providers and members covered under HealthPartners commercial pharmacy benefits.All HealthPartners updates
- Prior AuthReimbursement/Payment PolicyDiabetic Supply List — Product Catalog and Coverage GuidanceA formulary-style list of diabetic supplies typically covered under HealthPartners' diabetic supply benefit; coverage requires a prescription and items not on the list are not covered without prior authorization. Applies to members covered by HealthPartners diabetic supply benefit.All HealthPartners updates
- Prior AuthClinical/Medical PolicyFormulary prior authorization and step therapy coverage criteria (Commercial)HealthPartners commercial formulary guidance describing prior authorization (PA) and step therapy (ST) rules for pharmacy drugs; applies to providers and members under the commercial pharmacy benefits.All HealthPartners updates
- Prior AuthClinical/Medical PolicyFormulary prior authorization and step therapy coverage criteria (pharmacy)HealthPartners Commercial 2026 formulary document describing prior authorization and step therapy requirements for prescription drugs under the pharmacy benefit; applies to providers prescribing and pharmacies dispensing medications for affected members.All HealthPartners updates
- Prior AuthClinical/Medical PolicyMedicare Part D Medication Transition SupplyGoverns one-time transitional supplies of Part D medications for HealthPartners Medicare Part D enrollees (including new, switching, and long-term care residents) to cover immediate needs while prior authorizations, step therapy, or formulary changes are resolved.All HealthPartners updates
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Tool Description
Search HealthPartnersprior 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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