Meridian Prior Authorization Lookup
Latest Meridian prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-08-012026 Step Therapy Criteria — select CNS agents (antidepressants, antipsychotics, dextromethorphan/bupropion, trazodone)Defines Meridian Health Plan step therapy requirements for selected antidepressants, oral antipsychotics, dextromethorphan/bupropion products (Auvelity/Exxua), and trazodone; applies to prior authorization and coverage decisions for affected pharmacy products under Meridian's 2026 policy.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Actimmune (interferon gamma-1b) coveragePrior authorization policy for Actimmune covering FDA-approved indications and specific approval criteria for chronic granulomatous disease and malignant osteopetrosis; applies to Meridian Health Plan products requiring PA. Affects prescribers and patients seeking coverage for Actimmune.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2026-03-01Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Weight Management Benefit for Pediatric MembersDefines medical necessity and prior authorization requirements for liraglutide (Saxenda), semaglutide (Wegovy), and tirzepatide (Zepbound) when requested for chronic weight management in pediatric members through the EPSDT benefit; applies to Meridian Medicaid lines of business.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Exagamglogene autotemcel (Casgevy) gene therapy coverageDefines Meridian Health Plan medical necessity and authorization criteria for Casgevy (exagamglogene autotemcel) for patients with sickle cell disease or transfusion-dependent β-thalassemia, including required documentation and committee review. Affects providers submitting prior authorization for Medicaid line of business.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2025-08-01Finerenone (Kerendia) — Coverage Criteria for CKD with Type 2 DiabetesDefines medical necessity and prior authorization criteria for finerenone (Kerendia) for adult members with chronic kidney disease associated with type 2 diabetes under Meridian (Medicaid) lines of business.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2025-07-01Clinical Policy: Esketamine (Spravato)Defines Meridian Health Plan medical necessity and prior authorization criteria for esketamine (Spravato) for treatment-resistant depression and MDD with acute suicidal ideation/behavior for Illinois Medicaid line of business.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-01Agents for Epilepsy and SeizuresDefines prior authorization requirements, approval durations, and coverage criteria for specified antiepileptic agents for members covered by Meridian Health Plan (Medicaid line of business referenced). Affects providers requesting coverage for listed seizure/epilepsy medications.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2024-12-01Axitinib (Inlyta) — Coverage and Prior AuthorizationDefines medical necessity criteria, prior authorization requirements, and approval durations for axitinib (Inlyta) for Medicaid members, including FDA-approved and selected off-label indications and continuation criteria.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2024-09-01Clinical Policy: Brodalumab (Siliq)Covers Meridian's medical necessity and prior authorization criteria for brodalumab (Siliq) for treatment of moderate-to-severe plaque psoriasis in adults under Meridian IL Medicaid and affiliated Centene plans.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2024-04-22Clinical Policy: Amantadine ER (Gocovri)Defines medical necessity, prior authorization, and coverage criteria for Gocovri (amantadine ER) for dyskinesia and 'off' episodes in Parkinson's disease for Meridian lines of business.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2024-04-22Clinical Policy: Dupilumab (Dupixent)Clinical coverage and prior authorization criteria for dupilumab (Dupixent) across multiple FDA‑approved and select off‑label indications for Meridian Health Plan Medicaid members and providers.All meridian updates
- Prior AuthAdministrative/Operational PolicyEff. 2024-04-01Comprehensive Community Support Services Frequently Asked Questions (FAQ)Describes Meridian's prior authorization requirements and submission process for Comprehensive Community Support Services (codes H2015, H2016) for Meridian Medicaid and MMAI members, including timelines, documentation, and submission methods.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2024-03-16Treprostinil (Orenitram, Remodulin, Tyvaso, Tyvaso DPI) coverageDefines medical necessity, prior authorization, and coverage criteria for treprostinil formulations for treatment of pulmonary arterial hypertension (PAH) and pulmonary hypertension associated with interstitial lung disease (PH-ILD) for Meridian lines of business.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2024-03-01Aripiprazole Long-Acting Injections (Abilify Maintena, Abilify Asimtufii, Aristada, Aristada Initio)Defines medical necessity and prior authorization criteria for long-acting injectable aripiprazole products (Abilify Maintena, Abilify Asimtufii, Aristada, Aristada Initio) for Meridian Health Plan members; applies to prescribers requesting coverage under the listed Meridian/Centene policies.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2024-03-01Infliximab (Remicade, Inflectra, Renflexis, Avsola, Zymfentra)Medical necessity and prior authorization criteria for infliximab and listed biosimilars for Meridian Medicaid members across labeled inflammatory indications.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2024-03-01Non-Calcium Phosphate BindersDefines prior authorization criteria, dosing limits, and continuation requirements for non-calcium phosphate binders (Auryxia, Fosrenol, Renvela, Renagel, Velphoro) for members (Medicaid line of business) with CKD/ESRD or specified indications.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2024-02-01Duplicate TherapyDefines Meridian's restrictions and prior authorization requirements to prevent members from receiving excessive or duplicated medications within the same or similar drug classes; applies to Meridian IL Medicaid pharmacy claims and providers seeking overrides or prior authorization.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2024-01-01Cannabidiol (Epidiolex) coverageThis policy governs medical necessity criteria, approvals, and coverage parameters for Epidiolex (cannabidiol) for treatment of seizures associated with Dravet syndrome, Lennox-Gastaut syndrome, and tuberous sclerosis complex for Meridian Health Plan (Illinois Medicaid line of business). It affects providers requesting prior authorization for Epidiolex for covered members.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2023-12-01Betamethasone Dipropionate Spray (Sernivo)Policy governing medical necessity criteria, prior authorization, and coverage conditions for betamethasone dipropionate 0.05% spray (Sernivo) for Meridian Health Plan Medicaid members.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2023-12-01Clinical Policy: Deucravacitinib (Sotyktu)Defines medical necessity and prior authorization criteria for coverage of deucravacitinib (Sotyktu) for adults with moderate-to-severe plaque psoriasis under Meridian Health Plan (Medicaid line of business). Applies to providers requesting coverage for members.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2023-12-01Clinical Policy: Eteplirsen (Exondys 51)Defines Meridian Medicaid medical necessity and prior authorization criteria for eteplirsen (Exondys 51) for treatment of Duchenne muscular dystrophy patients with mutations amenable to exon 51 skipping; applies to providers seeking coverage under the payer's Medicaid line of business.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2023-12-01Colesevelam (WelChol) oral suspension packets — Coverage and prior authorization criteriaCoverage and prior authorization criteria for WelChol (colesevelam) packets for suspension for Meridian Health Plan Medicaid members, including indications, age limits, required trials, and dosing limits.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2023-12-01Etanercept (Enbrel) — Clinical PolicyDefines medical necessity criteria, prior authorization and continuation requirements for etanercept (Enbrel) for Meridian Health Plan Medicaid members across FDA‑approved indications and certain other uses.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2023-12-01Factor VIII (Human, Recombinant) prior authorization and coverageGoverns prior authorization, medical necessity, and coverage criteria for factor VIII products (human and recombinant) for treatment of hemophilia A and acquired hemophilia A under Meridian's Medicaid line of business.All meridian updates
- Prior AuthClinical/Medical PolicyEff. 2023-12-01Galcanezumab-gnlm (Emgality) coverageDefines medical necessity, prior authorization, and coverage criteria for Emgality (galcanezumab-gnlm) for migraine prophylaxis and episodic cluster headache for Meridian Health Plan Medicaid line of business.All meridian updates
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Tool Description
Search Meridianprior 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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