Sierra Health And Life Prior Authorization Lookup
Latest Sierra Health And Life prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Entyvio (vedolizumab) — Intravenous infusion medical benefit policyMedical policy governing medical-benefit coverage and prior authorization criteria for intravenously administered Entyvio (vedolizumab) for UnitedHealthcare Commercial and Individual Exchange plans.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Adakveo (crizanlizumab-tmca) – Medical Benefit Coverage CriteriaClinical policy governing medical-benefit coverage of Adakveo (crizanlizumab-tmca) for members with sickle cell disease under UnitedHealthcare Commercial and Individual Exchange plans. It defines initial and continuation therapy criteria, exclusions, and applicable codes for providers and prior authorization processes.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Crysvita (burosumab-twza) — Coverage Criteria for X-linked hypophosphatemia (XLH) and FGF23-related hypophosphatemia in TIOThis policy governs medical necessity criteria, prior authorization, and coding for Crysvita (burosumab-twza) for treatment of X-linked hypophosphatemia (XLH) and FGF23-related hypophosphatemia in tumor-induced osteomalacia (TIO) for applicable UnitedHealthcare commercial and individual exchange plans.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Essential 4-Tier Prescription Drug List (PDL) — Pharmacy Coverage CriteriaPDL governing pharmacy benefit coverage tiers, prior authorization, and coverage notes for Sierra Health and Life medical plan members enrolled in the Essential 4-Tier PDL; applies to medications and informs members and providers about formulary status and coverage requirements.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Omvoh (mirikizumab-mrkz) coverage for UC and CDThis policy governs medical and pharmacy benefit coverage and prior authorization requirements for Omvoh (mirikizumab-mrkz) for treatment of moderately to severely active ulcerative colitis and Crohn's disease for UnitedHealthcare Commercial and Individual Exchange plans.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Veopoz (pozelimab‑bbfg) — Medical Benefit Coverage Criteria for CD55‑deficient PLE (CHAPLE)This policy governs medical benefit coverage and prior authorization criteria for Veopoz (pozelimab‑bbfg) for members on UnitedHealthcare Commercial and Individual Exchange plans for treatment of CD55‑deficient protein‑losing enteropathy (PLE/CHAPLE). It applies to providers seeking coverage under those plans.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01FcRn blocker therapies for generalized myasthenia gravisCriteria and authorization requirements for medical benefit use of FcRn blockers (Imaavy, Rystiggo, Vyvgart, Vyvgart Hytrulo) to treat generalized myasthenia gravis (gMG) in specified antibody-positive patients; affects prescribers and prior authorization reviewers.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01Givosiran (Givlaari) — Coverage Criteria for Acute Hepatic PorphyriaMedical policy governing coverage criteria for givosiran (Givlaari) for treatment of adults with acute hepatic porphyria under specified benefit plans; applies to providers seeking authorization for therapy. Affects patients with diagnoses of AHP and clinicians/administrators requesting prior authorization.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01Leqembi (lecanemab-irmb) intravenous infusion — coverage criteriaMedical benefit policy governing coverage and prior authorization criteria for Leqembi (lecanemab-irmb) IV infusion for the treatment of Alzheimer's disease for Sierra Health and Life / UnitedHealthcare Commercial members.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01Respiratory Interleukins (Cinqair, Fasenra, & Nucala)Medical benefit drug policy governing provider-administered use of reslizumab (Cinqair), benralizumab (Fasenra), and mepolizumab (Nucala) for treatment of severe eosinophilic asthma and eosinophilic granulomatosis with polyangiitis (EGPA); affects prescribing providers, prior authorization reviewers, and members under Sierra Health and Life plans.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01Uplizna (inebilizumab-cdon) — Clinical Coverage CriteriaMedical policy governing clinical coverage criteria, prior authorization, and continuation requirements for Uplizna (inebilizumab-cdon) as treatment for neuromyelitis optica spectrum disorder (NMOSD), immunoglobulin G4-related disease (IgG4-RD), and generalized myasthenia gravis (gMG) for Sierra Health and Life members.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-03-01Tocilizumab (Actemra®, Tofidence™, & Tyenne®) Injection for Intravenous Infusion – Commercial Medical Benefit Drug PolicyMedical benefit drug policy governing use, prior authorization criteria, and coding for intravenous tocilizumab products (Actemra, Tofidence, Tyenne) across multiple indications including PJIA, SJIA, RA, GCA, CRS, acute GVHD, and immune checkpoint inhibitor-related toxicities. This part (1 of 2) contains preferred-product rules, indication-specific medical necessity criteria, and applicable procedure/diagnosis codes.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-01Cimzia (certolizumab pegol) coverageDefines medical necessity and prior authorization criteria for Cimzia (certolizumab pegol) under the commercial medical benefit, listing indications, required trials/attestations, prescriber specialties, and authorization durations. Applies to members covered under the payer's UnitedHealthcare Commercial medical benefit rules.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-01Infliximab (IV) products — coverage criteriaDefines medical necessity and prior authorization criteria for intravenous infliximab products (including specified biosimilars) across multiple indications for Sierra Health and Life members. Applies to providers requesting coverage under the medical benefit unless the product is self-administered subcutaneous infliximab obtained under pharmacy benefit as noted.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-01Leqembi (lecanemab-irmb) – Medical Benefit Coverage CriteriaCovers medical-benefit administration of intravenous Leqembi for members when criteria for treatment of early Alzheimer's disease are met; distinguishes formulation obtained under pharmacy benefit. Affects prescribers and prior authorization reviewers.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-01Tezspire (tezepelumab-ekko) — provider-administered therapyCovers clinical medical benefit criteria for provider-administered Tezspire (tezepelumab-ekko) as add-on maintenance therapy for severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP); affects providers submitting medical benefit prior authorizations for Sierra Health and Life members. (Part 1 of 3 — partial document.)All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Ambulance Services – Commercial and Individual Exchange Medical PolicyDefines medical necessity, coverage rationale, limitations, prior authorization rules, applicable codes, definitions, and clinical evidence for emergency and non-emergency ground and air ambulance services for UnitedHealthcare Commercial and Individual Exchange plans. This is Part 1 of 2 and includes criteria, exclusions, codes, and supporting evidence.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Deep Brain and Cortical StimulationClinical coverage policy for use of deep brain stimulation (DBS) and responsive cortical stimulation (RNS) for neurologic indications under UnitedHealthcare Commercial and Individual Exchange plans; affects providers seeking prior authorization and reimbursement for neurostimulation procedures.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Elevidys (delandistrogene moxeparvovec-rokl) — Medical Benefit Drug Policy (coverage criteria)Defines medical benefit coverage criteria and limits for Elevidys gene therapy for treatment of Duchenne muscular dystrophy (DMD) under UnitedHealthcare Commercial/Community Plan benefits; affects prescribers, infusion providers, and prior authorization reviewers.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01FcRn blockers (Rystiggo, Vyvgart, Vyvgart Hytrulo) coverage for gMG and CIDPDefines medical necessity criteria and prior authorization requirements for provider‑administered FcRn blocker therapies (rozanolixizumab, efgartigimod products) for generalized myasthenia gravis (gMG) and chronic inflammatory demyelinating polyneuropathy (CIDP) under Sierra Health and Life medical benefit.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Gazyva (obinutuzumab) — Medical Benefit Drug Policy for Active Lupus NephritisMedical benefit drug policy that governs coverage criteria for Gazyva (obinutuzumab) intravenous infusion for treatment of active lupus nephritis under Sierra Health and Life. Affects prescribers, infusion providers, and payers assessing prior authorization for this indication.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Ketalar (Ketamine) and Spravato (Esketamine) coverageDefines medical necessity and coverage criteria for Spravato (esketamine) nasal spray for treatment-resistant depression and MDD with acute suicidal ideation/behavior; describes coverage and investigational stances for ketamine injection and documents REMS-based administration and prior authorization requirements affecting providers.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Obstructive and Central Sleep Apnea TreatmentClinical policy governing medical necessity and coverage stance for non‑surgical and surgical treatments of obstructive and central sleep apnea for UnitedHealthcare Commercial and Individual Exchange plans. Affects providers submitting prior authorization and documentation for sleep apnea therapies and devices.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Orthognathic (Jaw) SurgeryDefines medical necessity criteria, coding, and coverage rationale for orthognathic (upper and/or lower jaw) reconstructive surgery for UnitedHealthcare Commercial and Individual Exchange plans; applies to clinical review and prior authorization decisions.All sierra health and life updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Outpatient Cardiology Procedures for EviCore Arrangement (for Oxford Only)Defines prior authorization, accreditation, payment, and coding requirements for outpatient cardiology imaging and diagnostic catheterization services managed by EviCore for Oxford members and participating providers.All sierra health and life updates
1–25 of 63
1 / 3
Tool Description
Search Sierra Health And Lifeprior 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.
Prior Authorization by Payer
Go deeper
Explore OpenPayer Data
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.
Toolbox
More OpenPayer Tools
- Billing Code LookupSearch CPT, HCPCS, J-codes, DRG, and dental codes by number or procedure name.
- Healthcare Provider & Facility LookupFind hospitals and healthcare facilities by name, taxonomy, facility type, ownership, or state.
- Health Insurance Payer LookupSearch national health insurance payers and health plans by name and state presence.
- Provider Taxonomy Code LookupSearch NUCC taxonomy codes by code, specialty, grouping, or classification.
- CPT Modifier LookupSearch CPT modifiers by code or name — descriptions, when to use them, and payer policy context.
- Timely Filing LookupFind payer timely filing policies: claim deadlines, corrected claim windows, and appeal timeframes.
- Coverage Criteria LookupSearch payer coverage criteria and medical necessity requirements by drug, procedure, or payer.
- Payer Contact DirectoryClaims, prior authorization, provider services, and appeals contacts for health insurance payers.
Published by
Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.