Premerabluecrossofwashington Prior Authorization Lookup
Latest Premerabluecrossofwashington prior authorization updates19
- Prior AuthClinical/Medical PolicyEff. 2027-02-05Selective Estrogen Receptor Modulators and Down RegulatorsThis policy governs medical-necessity and prior-authorization criteria for selected brand SERMs and SERDs used to treat metastatic or advanced hormone-receptor-positive breast cancer. It applies to providers submitting requests for Fareston, Cligavyx, Faslodex, Inluriyo, Orserdu, and Veppanu.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyEff. 2027-02-05Selective Estrogen Receptor Modulators and Down RegulatorsThis policy governs medical-necessity coverage and prior authorization for specified brand SERMs and SERDs used primarily to treat advanced, metastatic, or recurrent hormone-receptor-positive breast cancer. It applies to providers submitting requests for Fareston, Cligavyx, Faslodex, Inluriyo, Orserdu, or Veppanu.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyEff. 2027-02-05Selective Estrogen Receptor Modulators and Down RegulatorsThis policy governs medical-necessity and prior-authorization criteria for selected brand SERMs and SERDs used to treat metastatic or advanced hormone-receptor-positive breast cancer. It applies to providers requesting coverage for Fareston, Cligavyx, Faslodex, Inluriyo, Orserdu, or Veppanu.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyEff. 2027-01-01Pharmacologic Treatment of Psoriatic ArthritisThis policy governs medical-necessity, prior-authorization, step-therapy, and site-of-service review for biologic and other pharmacologic treatments of active psoriatic arthritis. It applies to members of all ages for specified intravenous and injectable drugs, with site-of-service review generally applying to members age 13 and older; Alaska fully insured members are exempt from the site-of-service criteria.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyEff. 2027-01-01Pharmacologic Treatment of Psoriatic ArthritisGoverns medical necessity, prior authorization, step therapy, and site-of-service review for biologic and other pharmacologic treatments of active psoriatic arthritis.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyEff. 2027-01-01Site of Service for Selected Elective Surgical and Diagnostic ProceduresThis policy governs medical necessity review of the location where certain listed elective procedures are performed, including ambulatory surgical centers, outpatient hospitals, and inpatient hospitals. The procedure itself is not subject to medical necessity review under this policy; providers must obtain prior authorization for site of service when required and document why a higher-cost setting is appropriate.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyEff. 2026-11-01BCL-2 InhibitorsThis policy governs pharmacy-benefit coverage and prior authorization for Beqalzi (sonrotoclax) and Venclexta (venetoclax). It describes medically necessary uses, dosing limits, authorization durations, documentation requirements, and investigational uses for provider-submitted requests.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyEff. 2026-11-01BCL-2 InhibitorsThis policy governs pharmacy-benefit coverage and prior authorization for Beqalzi (sonrotoclax) and Venclexta (venetoclax), including medically necessary uses, clinical criteria, documentation, dosing limits, authorization durations, and investigational uses for specified hematologic malignancies.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyEff. 2026-11-01Bispecific Antibody Drug CoverageThis policy governs medical-necessity review and prior authorization for selected bispecific antibody drugs used to treat cancer. The drugs are managed through the medical benefit and apply to providers submitting coverage requests for eligible individuals.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyEff. 2026-11-01Chronic Hepatitis B and D Antiviral TherapyThis policy governs medical-necessity and prior-authorization criteria for selected antiviral drugs used to treat chronic hepatitis B virus and hepatitis D virus infection.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyEff. 2026-11-01Inhaled CorticosteroidsThis policy governs pharmacy-benefit coverage and prior authorization for selected inhaled corticosteroids used to treat asthma. It applies to providers evaluating medical necessity and does not apply to Medicare Advantage.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyEff. 2026-11-01Selective Estrogen Receptor Modulators and Down RegulatorsThis policy governs medical-necessity and prior-authorization criteria for brand selective estrogen receptor modulators and selective estrogen receptor down-regulators used primarily for hormone-receptor-positive breast cancer. It applies to providers submitting requests under the pharmacy benefit and, for Faslodex, the pharmacy or medical benefit.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyEff. 2026-11-01Tumor Treating Fields TherapyThis policy governs coverage and prior authorization for tumor treating fields therapy. Coverage is provided with criteria for adults with newly diagnosed supratentorial glioblastoma multiforme or grade IV astrocytoma after initial treatment and during temozolomide maintenance; TTF is investigational and not covered for other conditions described in the policy.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyEff. 2026-11-01Tumor Treating Fields TherapyCoverage and prior authorization for tumor treating fields therapy, limited to adults with newly diagnosed supratentorial glioblastoma multiforme or grade IV astrocytoma who meet specified performance-status, prior-treatment, and maintenance-temozolomide requirements; other uses are investigational and not covered.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Adult Sinus Surgery CoverageCoverage criteria, prior authorization, site-of-service review, documentation, and coding requirements for elective sinus surgery in individuals aged 19 and older, including FESS, revision FESS, and balloon sinus ostial dilation.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyPegasys (peginterferon alfa-2a) CoverageMedical-necessity and prior-authorization coverage for Pegasys, including covered uses, documentation, authorization duration, and pharmacy-benefit administration.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyPegasys (peginterferon alfa-2a) Coverage CriteriaThis policy governs medical-necessity review and prior authorization for Pegasys under the pharmacy benefit for specified hepatitis B, hepatitis C, hepatitis D, essential thrombocytopenia, and myelofibrosis indications.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyZurzuvae (zuranolone) for Postpartum DepressionThis policy governs pharmacy-benefit coverage and prior authorization for oral Zurzuvae (zuranolone) in adults with postpartum depression who meet specified diagnostic, severity, postpartum timing, age, and treatment-duration requirements.All premerabluecrossofwashington updates
- Prior AuthClinical/Medical PolicyZurzuvae (zuranolone) for postpartum depressionThis policy governs pharmacy-benefit coverage and prior authorization for Zurzuvae (zuranolone) used to treat postpartum depression. It applies to individuals seeking coverage and providers submitting medical-necessity documentation.All premerabluecrossofwashington updates
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Tool Description
Search Premerabluecrossofwashingtonprior 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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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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