Medimpact Prior Authorization Lookup
Latest Medimpact prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Ophthalmic Prostaglandin Analog Prior Authorization CriteriaThis document governs prior authorization criteria and coverage updates for ophthalmic prostaglandin analog agents for Kentucky Medicaid (Fee-for-Service and MCO) members, effective September 1, 2026. It affects pharmacy providers and prescribers submitting PA requests for the listed agents.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Somatostatin analog prior authorization criteria updatesUpdates to prior authorization (PA) criteria for somatostatin analog agents affecting Kentucky Medicaid prescribers and pharmacy providers (Fee-for-Service and MCO members). Effective September 1, 2026.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Tretinoin prior authorization criteria (Kentucky Medicaid)Defines new prior authorization clinical criteria for tretinoin formulations for Kentucky Medicaid (Fee-for-Service and MCO) effective June 1, 2026; affects pharmacy providers, prescribers, and beneficiaries covered by Kentucky Medicaid.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Furoscix Injection Kit Prior Authorization CriteriaDefines Kentucky Medicaid prior authorization requirements for Furoscix Injection Kit for outpatient short-term parenteral diuresis, affecting prescribers, pharmacy providers, and Kentucky Medicaid members.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01GLP-1 receptor agonist product switch limitDefines a limit on the number of times Kentucky Medicaid members may switch between GLP-1 receptor agonist products and describes prior authorization requirements for exceeding the limit; applies to Commonwealth of Kentucky Medicaid (Fee-for-Service and MCO) members and their providers.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-15Pharmacy drug policy updates and PA criteria (Kentucky Medicaid highlights)Quarterly pharmacy newsletter summarizing drug recalls, product discontinuations, prior authorization criteria and billing guidance affecting Kentucky Medicaid providers, pharmacies, and payers.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01Prior authorization for hypertonic saline (3% and 7%)MedImpact is implementing prior authorization requirements for specified hypertonic saline NDCs effective April 1, 2026 for Kentucky Medicaid; this affects prescribers and pharmacies dispensing the listed products. Grandfathering is provided for members with recent paid claims through May 1, 2026.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2026-03-15Hypertonic saline prior authorization for Kentucky MedicaidEstablishes prior authorization requirements and coverage criteria for specified hypertonic saline NDCs for Kentucky Medicaid members (MCO and FFS); affects prescribers and pharmacies submitting PA requests to MedImpact for Kentucky Medicaid.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-10Wegovy Prior Authorization (Kentucky Medicaid)Rules for prior authorization of Wegovy for Kentucky Medicaid members managed by MedImpact, including restriction to a single Wegovy formulation per member and procedures when switching formulations.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2025-10-01Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Prior Authorization CriteriaMedImpact/Kentucky DMS prior authorization criteria for GLP-1 receptor agonists for members with Type 2 Diabetes Mellitus, including new renewal requirements emphasizing recent A1c lab monitoring; affects Kentucky Medicaid prescribers and MCO/FFS pharmacy prior authorizations.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2025-08-29Concurrent use of DPP-4 inhibitors and GLP-1 agonistsThis policy implements a hard edit prohibiting concurrent pharmacy claims for GLP-1 agonists and DPP-4 inhibitors for Kentucky Medicaid members; it affects pharmacy providers submitting claims and prior authorization staff managing transitions. Applies to Kentucky Medicaid (MCO and FFS) as communicated by MedImpact.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2025-08-14Influenza Vaccine Coverage (2025-2026)Governs which influenza vaccines the Commonwealth of Kentucky Medicaid (Managed Care and Fee-for-Service) will cover for the 2025–2026 flu season and provides contact/prior authorization information for providers.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2025-07-01Hemlibra (emicizumab-kxwh) prior authorization for Hemophilia ADefines prior authorization (PA) criteria and renewal requirements for Hemlibra for Kentucky Medicaid members, including approval durations, clinical documentation, therapy transition and breakthrough bleed protocols. Affects prescribers and pharmacy prior authorization processes for Kentucky Medicaid (Commonwealth of Kentucky DMS).All medimpact updates
- Prior AuthReimbursement/Payment PolicyEff. 2025-02-01GLP-1 Agents Maximum Per Fill LimitDefines maximum per-fill quantities for specified GLP-1 receptor agonist products for Commonwealth of Kentucky Medicaid (Fee-for-Service and Managed Care) and describes prior authorization handling when requests exceed those limits.All medimpact updates
- Prior AuthAdministrative/Operational PolicyEff. 2024-07-15Generic Elidel (pimecrolimus 1% cream) SCC 02 override for shortagesTemporary authorization allowing pharmacies to use submission clarification code (SCC) 02 to bypass prior authorization for pimecrolimus 1% cream (generic Elidel) when a true wholesaler shortage of the brand exists; applies to Kentucky Medicaid pharmacy providers served by MedImpact.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2023-01-19Immune globulins (IVIG, SCIG) pharmacy coverage criteriaDescribes Kentucky Medicaid pharmacy coverage and POS/prior authorization (PA) requirements for intravenous and subcutaneous immune globulin products, and what documentation is required for PA. Affects providers dispensing/administering IVIG or SCIG for Kentucky Medicaid members.All medimpact updates
- Prior AuthReimbursement/Payment PolicyEff. 2022-04-01Botulinum toxin reimbursement routing — Medical-only reimbursement (Kentucky Medicaid)This notice informs Kentucky Medicaid pharmacy and prescriber networks that, effective April 1, 2022, botulinum toxin products will be reimbursed only through the Medical benefit and prior authorization must be obtained via the member's MCO medical benefit or fee-for-service Medical benefit.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2022-01-10No prior authorization required for non-preferred antidepressantsTemporary policy removing prior authorization requirements for specified non-preferred antidepressant medications for Commonwealth of Kentucky Medicaid members, in response to tornadoes and supply issues.All medimpact updates
- Prior AuthAdministrative/Operational PolicyEff. 2022-01-01Arizona Substantive Policy Statement: Uniform Prior Authorization Request Forms and Prior Authorization RequirementsThis Substantive Policy Statement adopts two standardized prior authorization request forms and provides guidance on Arizona's prior authorization laws for health insurers, providers, utilization review agents, and related stakeholders in Arizona.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2021-12-13Antidepressants — preferred generics and temporary PA waiverTemporary change to preferred coverage and prior authorization requirements for specified generic antidepressants for Commonwealth of Kentucky Medicaid Pharmacy Network members, effective immediately through January 5, 2022.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2021-07-01Kentucky SB 51 — prior authorization exceptions and safety edit procedures (pharmacy)Describes prior authorization requirements and exceptions for specified opioid use disorder and related medications in response to Kentucky Senate Bill 51 (effective July 1, 2021); affects Kentucky Medicaid pharmacy network dispensing and PA workflows for these products.All medimpact updates
- Prior AuthClinical/Medical PolicyAprocitentan (Tryvio) — formulary recommendation for treatment‑resistant hypertensionSummarizes P&T committee recommendation to add Tryvio (aprocitentan) as Non‑PDL and the initial and renewal prior‑authorization criteria for treatment‑resistant hypertension; intended for prescribers and prior authorization reviewers.All medimpact updates
- Prior AuthClinical/Medical PolicyBerdazimer (Zelsuvmi) and related dermatology coverage decisions (including Vykat XR and Andembry) - Coverage CriteriaDefines P&T Committee recommendations and prior authorization criteria for berdazimer (Zelsuvmi) topical antiviral for molluscum contagiosum and adds coverage rules for newly listed products (Vykat XR, Andembry) including age, quantity, prescriber and documentation requirements.All medimpact updates
- Prior AuthClinical/Medical PolicyBrensocatib (BRINSUPRI) for non-cystic fibrosis bronchiectasisThis policy governs prior authorization, approval duration, and renewal criteria for BRINSUPRI (brensocatib) for treatment of non-cystic fibrosis bronchiectasis for MedImpact members and prescribers.All medimpact updates
- Prior AuthClinical/Medical PolicyBrensocatib (Brinsupri) and class-level PA updates — Coverage CriteriaDefines P&T recommendations and prior authorization criteria for Brinsupri (brensocatib) for non‑cystic fibrosis bronchiectasis and adds multiple new products with specified initial/renewal criteria and PA requirements.All medimpact updates
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Tool Description
Search Medimpactprior 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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