Peach State Health Plan Prior Authorization Lookup
- Peach State Health Plan timely filing
- Peach State Health Plan coverage criteria
- All Peach State Health Plan policy updates
Latest Peach State Health Plan prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2025-08-16Clinical Policy: Etanercept (Enbrel)Defines medical necessity, prior authorization, and utilization rules for etanercept (Enbrel) for Peach State Health Plan (Medicaid) members across labeled rheumatologic and dermatologic indications.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2024-09-17Glecaprevir/Pibrentasvir (Mavyret) coverageDefines medical necessity, approval criteria, dosing limits, contraindications, and treatment interruption guidance for Mavyret for Medicaid members. Affects prescribers and pharmacy/medical authorization staff processing prior authorization requests.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2024-07-20Elbasvir/Grazoprevir (Zepatier) — Coverage CriteriaDefines medical necessity criteria, prior authorization requirements, and dosing/administration guidance for Zepatier (elbasvir/grazoprevir) for members covered under Peach State Health Plan (Medicaid). Applies to providers requesting coverage for Zepatier.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2024-07-20Ledipasvir/Sofosbuvir (Harvoni) — Coverage CriteriaDefines medical necessity, prior authorization requirements, and approval criteria for Harvoni for Peach State Health Plan Medicaid members, including age, genotype, cirrhosis, and alternative-preferred therapy requirements.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2024-04-07Preferred Drug List (PDL) Governance and Pharmacy ManagementDefines the Centene Preferred Drug List (PDL) governance, pharmacy management controls (e.g., prior authorization, quantity limits, step therapy), and processes for maintaining and updating the PDL for Peach State Health Plan (Medicaid). Affects plan pharmacy departments, Centene P&T, CPAC, SDC, providers, and members.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2023-12-08Lovotibeglogene autotemcel (Lyfgenia) — Clinical PolicyDefines medical necessity and prior authorization criteria for Lyfgenia (lovotibeglogene autotemcel) for patients with sickle cell disease and related administrative guidance for other indications and continued therapy across Peach State Health Plan lines of business.All Peach State Health Plan updates
- Prior AuthAdministrative/Operational PolicyEff. 2023-10-06Pharmacy ProgramDefines Peach State Health Plan's pharmacy program governance, utilization management, prior authorization, DUR, P&T committee roles, and pharmacist responsibilities for Medicaid Members and P4HB Enrollees.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2023-09-17Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi) coverageDefines medical necessity and prior authorization criteria for Vosevi for treatment of chronic hepatitis C virus (HCV) infection for Medicaid members served by Peach State Health Plan.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2023-03-12Thyrotropin alfa (Thyrogen) coverageDefines medical necessity, prior authorization, dosing, and continuity criteria for Thyrogen (thyrotropin alfa) for members under Peach State Health Plan lines of business including Commercial, HIM/ICHRA, and Medicaid.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2023-01-01Casimersen (Amondys 45) coverageMedical necessity and prior authorization criteria for use of casimersen (Amondys 45) for Duchenne muscular dystrophy in Peach State Health Plan Medicaid members.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2023-01-01Clinical Policy: Golodirsen (Vyondys 53)Defines medical necessity and prior authorization criteria for golodirsen (Vyondys 53) for treatment of Duchenne muscular dystrophy (DMD) in Medicaid members whose DMD mutations are amenable to exon 53 skipping.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2021-10-01Elexacaftor/Ivacaftor/Tezacaftor; Ivacaftor (Trikafta) Coverage CriteriaDefines medical necessity and prior authorization criteria for Trikafta for Peach State Health Plan Medicaid members with cystic fibrosis, including initial and continued therapy requirements, dosing limits, and documentation expectations.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2021-08-16Clinical Policy: Apremilast (Otezla)Defines medical necessity, prior authorization, and renewal criteria for apremilast (Otezla) for Medicaid members, covering FDA-labeled indications and certain off-label pathways; applies to providers prescribing for Peach State Health Plan members.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2021-04-01Clinical Pharmacy Services Inter-raterDefines Peach State Health Plan's process for assessing clinical pharmacists' consistency and validity in prior authorization (PA) application and decision making; applies to the Pharmacy Department clinical pharmacists reviewing PA requests for Peach State products (Medicaid, Ambetter).All Peach State Health Plan updates
- Prior AuthAdministrative/Operational PolicyEff. 2020-10-01Transition of CareEstablishes Peach State Health Plan's process to provide continuity of prescription drug therapy for new members transitioning from another insurer, including a one-time 30-calendar-day coverage for medications that would otherwise require prior authorization. Applies to the Peach State Health Plan Pharmacy Department and Medicaid product members.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2020-06-01Ubrogepant (Ubrelvy) — Coverage Criteria for Acute MigraineDefines medical necessity and prior-authorization criteria for ubrogepant (Ubrelvy) for the acute treatment of migraine in adults under Peach State Health Plan (Medicaid). Applies to providers requesting coverage through the Centene-affiliated benefit.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2020-03-01Avapritinib (Ayvakit) coverageDefines medical necessity, prior authorization, and coverage criteria for avapritinib (Ayvakit) for commercial, HIM, and Medicaid lines of business at Peach State Health Plan.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2020-01-21Clinical Policy: Teprotumumab (Tepezza)Defines medical benefit coverage and prior authorization criteria for teprotumumab (Tepezza) for treatment of thyroid eye disease (TED) for applicable Peach State Health Plan lines of business.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2019-09-01Clinical Policy: Erdafitinib (Balversa) coverageClinical coverage and prior authorization criteria for erdafitinib (Balversa) for treatment of urothelial carcinoma and select off-label NCCN-recommended uses, applicable to Peach State Health Plan lines of business including Commercial, HIM/ICHRA, and Medicaid.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2019-03-01Icosapent ethyl (Vascepa) coverageDefines medical necessity, prior authorization, and continuation criteria for icosapent ethyl (Vascepa) for Peach State Health Plan members (HIM/ICHRA, Medicaid). Applies to provider requests for Vascepa coverage under the referenced plan.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2018-09-19Dipeptidyl Peptidase-4 (DPP-4) InhibitorsDefines prior authorization, coverage criteria, and limitations for dipeptidyl peptidase-4 (DPP-4) inhibitor products for Peach State Health Plan Medicaid members (adult type 2 diabetes mellitus).All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2018-09-19Glucagon-Like Peptide-1 (GLP-1) Receptor AgonistsDefines medical necessity, prior authorization, and coverage criteria for GLP-1 receptor agonist agents for Peach State Health Plan Medicaid members, including initial and continuation therapy rules and limitations of use.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2018-09-01Corticosteroids for Ophthalmic Injection (Dextenza, Iluvien, Ozurdex, Retisert, Xipere, Yutiq)Defines prior authorization, medical necessity, and coverage criteria for ophthalmic corticosteroid products (Dextenza, Iluvien, Ozurdex, Retisert, Xipere, Yutiq) for Peach State Health Plan members across Commercial, HIM/ICHRA, and Medicaid lines of business.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2018-03-13Age Limit Override (Codeine, Tramadol, Hydrocodone)Defines prior authorization requirements and clinical criteria for use of codeine-, tramadol-, and hydrocodone-containing medications in pediatric and other patients where FDA labeling imposes age limits; applies to Peach State Health Plan lines of business listed in the policy.All Peach State Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2017-06-01Telotristat Ethyl (Xermelo) CoverageDefines medical necessity and prior authorization criteria for telotristat ethyl (Xermelo) for treatment of carcinoid syndrome diarrhea for Peach State Health Plan members across covered lines of business.All Peach State Health Plan updates
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Tool Description
Search Peach State Health Planprior 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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