Mediviewcurative Prior Authorization Lookup
Latest Mediviewcurative prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-04-28Radiation Therapy Policy (Coverage Criteria for EBRT, SBRT/SRS, PBT, Brachytherapy, SRT)Clinical criteria and coding policy governing medical necessity, prior authorization, and billing for radiation therapy services (multiple modalities) for members of Curative Health Plan in specified states and age groups.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01Behavioral Health and Substance Use Disorder Services (Members 18 and Over)Defines coverage, prior authorization, and medical necessity criteria for behavioral health and substance use disorder services for members aged 18 and older across outpatient, IOP, partial hospitalization, and inpatient settings, including specialized services (ABA, TMS, ECT). Affects providers contracting with Curative Health Plan for applicable products.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01Behavioral Health and Substance Use Disorder Services (Members Under 18)Defines medical necessity, prior authorization, coding, and delivery rules for behavioral health, SUD, and specialized services (including ABA, evaluations, TMS, ECT) for members birth through age 17 in Curative Health Plan commercial products and specified states.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyEff. 2025-05-05Site of service for covered medical servicesDefines preferred and non-preferred settings for delivering Curative-covered medical and certain pharmacy services and the medical necessity criteria and authorization process that determine when higher-cost settings are appropriate. Applies to all Curative members and providers requesting prior authorization for services.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyEff. 2024-04-12Abatacept (Orencia) intravenous therapy coverageDefines medical necessity and precertification requirements for intravenous abatacept (Orencia IV) for Curative members, including initial and continuation criteria across rheumatologic and transplant-related indications and prescriber specialty requirements.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyEff. 2023-12-01Multiple Sclerosis medications (brand selection) including Lemtrada, Ocrevus, Mitoxantrone, IV steroidsThis policy governs medical and pharmacy utilization management (precertification and coverage criteria) for multiple sclerosis (MS) therapies for Curative Health Plan members and participating providers.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyEff. 2023-11-01Applied Behavioral Analysis (ABA) TherapyThis policy governs precertification, documentation, and medical necessity criteria for outpatient ABA services for members with Autism Spectrum Disorder (ASD) and is intended for use by the Medical Utilization Management department and participating providers.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyEff. 2023-10-01Acupuncture PolicyDefines medical necessity, exclusions, and preauthorization considerations for acupuncture services provided to members managed by the Medical Utilization Management department.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyEff. 2023-10-01Intravitreal VEGF inhibitors — preferred agent selection and prior authorizationDefines preferred anti-VEGF agents (Avastin first-line, then Cimerli/Byooviz after Avastin trial) and prior authorization/medical necessity criteria for intravitreal VEGF inhibitors for specified retinal disorders; applies to Curative Health Plan medical and pharmacy utilization management staff and providers seeking coverage.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyEff. 2023-10-01Spinal Surgery - Laminectomy and Fusion PolicyDefines Curative's clinical, safety, and medical-necessity criteria and pre-operative requirements for spinal laminectomy and fusion procedures used in utilization review, pre-authorization, and clinical decision-making for Curative Medical UM operations.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyEff. 2022-06-13Transgender Affirmation Policy and Procedure (Gender-Affirming Care Coverage Criteria)This policy governs coverage, prior authorization, and clinical criteria for gender-affirming medical and surgical treatments for members of Curative Health Plan; it affects members seeking gender-affirming care and providers/credentialed utilization review staff processing these requests.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyATTR Amyloid Cardiomyopathy Prior Authorization Drug List ADefines prior authorization criteria and approval durations for tafamidis (Vyndaqel, Vyndamax) and acoramidis (Attruby) when used to treat transthyretin (ATTR) amyloid cardiomyopathy for members of Curative Health Plan.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyActhar Gel (repository corticotropin) prior authorizationDefines prior authorization criteria for Acthar Gel (repository corticotropin) for members of Curative Health Plan, specifying approved indication (infantile spasms) and that other uses are not considered medically necessary.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyAlhemo Prior Authorization — Hemophilia A/B with inhibitorsDefines prior authorization requirements for Alhemo when used to treat Hemophilia A or B with inhibitors for members of Curative Health Plan. Applies to requests for initial and continued therapy and specifies documentation and specialist involvement requirements.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyAlpha-1 Proteinase InhibitorsMedical necessity policy for use, precertification, and continuation of alpha-1 proteinase inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) for treatment of emphysema due to alpha1-antitrypsin deficiency; applies to Medical and Pharmacy Utilization Management departments and participating providers/members.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyBenlysta (belimumab) prior authorizationDefines medical necessity criteria and prior authorization requirements for Benlysta (belimumab) for members of Curative Health Plan when used for FDA‑approved indications (systemic lupus erythematosus and lupus nephritis). Applies to prescribers submitting requests for coverage.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyBiologic immunomodulators prior authorizationDefines prior authorization coverage criteria and approval durations for specified biologic immunomodulator drugs when used for compendia-supported indications across multiple immune-mediated diseases; applies to providers submitting PA requests to Curative Health Plan.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyCFTR modulator prior authorization (Kalydeco, Symdeko, Trikafta)Prior authorization requirements for CFTR modulator drugs (Kalydeco, Symdeko, Trikafta) for members of Curative Health Plan; governs initial and continued therapy approval conditions and required documentation for prescribers and specialists.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyCFTR modulator prior authorization (Kalydeco, Trikafta, Symdeko, Orkambi)Defines prior authorization clinical criteria, documentation, and approval durations for CFTR modulator drugs (Kalydeco, Trikafta, Symdeko, Orkambi) for members of Curative Health Plan. Applies to prescribers requesting coverage for these FDA‑approved CFTR modulator indications.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyCarbaglu (carglumic acid) prior authorizationDefines prior authorization requirements for Carbaglu (carglumic acid) soluble tablets for FDA‑approved indications, specifying initial and continued therapy criteria for NAGS deficiency, methylmalonic acidemia (MMA), and propionic acidemia (PA). Affects providers requesting coverage under Curative Health Plan.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyCladribine (Mavenclad) Prior AuthorizationDefines prior authorization requirements for cladribine (Mavenclad) for treatment of relapsing forms of multiple sclerosis for members of Curative Health Plan; applies to prescribers requesting coverage.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyCoagadex (Factor X) prior authorizationDefines prior authorization requirements for coverage of Coagadex for treatment of hereditary Factor X deficiency under the Curative Health Plan; applies to providers requesting this drug for plan members.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyColony Stimulating Factors (CSF) Prior AuthorizationDefines prior authorization coverage criteria for short- and long-acting colony stimulating factor drugs (e.g., filgrastim, pegfilgrastim) for Curative Health Plan members; applies to provider requests for CSF medications.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyDescovy (emtricitabine/tenofovir alafenamide) prior authorizationDefines prior authorization requirements for Descovy (emtricitabine/tenofovir alafenamide) for HIV pre-exposure prophylaxis (PrEP) and HIV treatment for members of Curative Health Plan (operating as Curative). Applies to requests for Descovy under the payer's drug coverage.All mediviewcurative updates
- Prior AuthClinical/Medical PolicyDisposable Insulin Pumps Prior AuthorizationDefines prior authorization requirements for disposable insulin infusion pumps (eg, Omnipod products) for members of Curative Health Plan; applies to initial and continued therapy determinations for insulin-requiring diabetes.All mediviewcurative updates
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Tool Description
Search Mediviewcurativeprior 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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