Univerahealthcare Prior Authorization Lookup
Latest Univerahealthcare prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-06-18Applied Behavior Analysis (ABA)Defines medical necessity, documentation, and provider requirements for Applied Behavior Analysis services for members with DSM-5-TR diagnoses; applies to coverage determinations and prior authorization for ABA services under Univera Healthcare.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-03-16Airway Clearance DevicesCovers medical necessity and coverage criteria for airway clearance devices (HFCC, IPV, MI‑E) including repair and replacement rules, documentation and prior authorization expectations for Univera Healthcare members.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Cytomegalovirus (CMV) — Pharmacy Management Drug PolicyDefines prior authorization, clinical criteria, and utilization management for drugs used to prevent or treat CMV in Univera Healthcare members across applicable lines of business.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2025-12-01Immune Thrombocytopenia (ITP) PolicyPharmacy management drug policy defining coverage criteria, prior authorization, quantity limits, and recertification requirements for therapies used to treat immune thrombocytopenia (ITP) and related thrombocytopenia indications; applies to Univera Healthcare lines of business listed in the document.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2025-10-01Encelto (revakinagene taroretcel-lwey) ImplantPayer drug policy governing coverage and utilization management for the Encelto implant for treatment of idiopathic Macular Telangiectasia Type 2 across Univera Healthcare lines of business; affects prescribing ophthalmologists and network prior-authorization reviewers.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2025-07-01Testosterone (Testopel, Aveed, Azmiro) PolicyDefines coverage and prior authorization criteria for Aveed, Azmiro, and Testopel injectable/implantable testosterone products across Univera Healthcare commercial, Medicaid, Medicare Advantage, and other lines of business (except Medicare Part D where noted).All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2025-06-01Parkinson's Disease — Pharmacy Management Drug PolicyPharmacy management drug policy governing coverage and prior authorization criteria for medications used to treat Parkinson's disease for Univera Healthcare lines of business.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2025-05-01Ryoncil (remestemcel-l-rknd) — Coverage CriteriaPolicy governing prior authorization and medical benefit coverage for Ryoncil, an allogeneic MSC therapy for pediatric steroid‑refractory acute graft‑versus‑host disease (SR‑aGVHD); applies to multiple lines of business listed by the payer.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-01Low Clinical Impact Drugs - RxDefines Univera Healthcare's coverage stance and drug-specific requirements for 'low clinical impact' prescription drugs across applicable commercial and public plan lines of business; affects prescribers, pharmacists, and prior authorization staff for the listed products.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2024-10-20Site of Care Redirection for Medical Specialty Drug AdministrationDefines medical necessity and prior authorization criteria determining appropriate outpatient site of care (hospital outpatient, ambulatory infusion center, physician office, or home) for administration of select medical specialty drugs covered under the medical benefit for Univera Healthcare lines of business.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2024-06-01Lyfgenia (lovotibeglogene autotemcel) — Coverage CriteriaDefines medical necessity and prior authorization criteria for Lyfgenia (lovotibeglogene autotemcel) for members across applicable lines of business, including clinical eligibility, exclusions, and utilization rules for one-time gene therapy administration.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2024-04-01Elevidys (delandistrogene moxeparvovec-rokl) coverage and authorizationClinical coverage and utilization management rules for Elevidys gene therapy for Duchenne muscular dystrophy across multiple lines of business for Univera Healthcare; affects prescribers, infusion providers, and prior authorization reviewers.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2024-04-01Qalsody (tofersen) — Coverage and Prior Authorization PolicyDefines Univera Healthcare's coverage and prior authorization requirements for Qalsody (tofersen) across applicable lines of business; affects providers seeking medical-benefit coverage for intrathecal administration of Qalsody.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2024-02-01Intravenous Iron Replacement ProductsThis pharmacy management drug policy governs prior authorization and coverage criteria for intravenous iron replacement products (e.g., Injectafer, generic ferric carboxymaltose, Feraheme, Venofer, Ferrlecit, Infed, Monoferric) across multiple lines of business for Univera Healthcare members.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2023-08-01Xiaflex (collagenase clostridium histolyticum) coverageMedical benefit policy governing coverage criteria and utilization management for Xiaflex injections for Dupuytren's contracture and Peyronie's disease across Univera Healthcare lines of business; applies to providers administering the drug and prior authorization reviewers.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2023-05-11Amyotrophic Lateral Sclerosis (ALS) — Pharmacy Management Drug PolicyDefines pharmacy coverage, prior authorization and recertification requirements for FDA-approved and related ALS drugs (riluzole oral suspension, edaravone formulations, others noted) for Univera Healthcare members across listed product lines.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2023-02-01Hemophilia Gene TherapiesDefines medical benefit coverage, prior-authorization requirements, and eligibility criteria for Hemgenix and Roctavian gene therapies for adults with hemophilia A or B across Univera Healthcare lines of business (excluding Medicare Part D).All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2022-04-26Chimeric Antigen Receptor T Cell (CAR-T) TherapyDefines prior authorization, coverage criteria, and utilization management for FDA-approved CAR-T cellular therapies administered under Univera Healthcare medical/pharmacy benefits across specified lines of business.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2022-02-10Tezspire (tezepelumab-ekko) coverageDefines prior authorization, coverage criteria, and utilization management for Tezspire (tezepelumab-ekko) as an add-on maintenance treatment for severe asthma and for chronic rhinosinusitis with nasal polyps across applicable Univera Healthcare lines of business.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2020-12-01Immune Checkpoint Inhibitor Clinical Review Prior Authorization (CRPA)Defines prior-authorization (Clinical Review Prior Authorization, CRPA) criteria for oncologic immune checkpoint inhibitor drugs across Univera Healthcare lines of business (excluding Medicare Part D). Applies to provider requests for coverage of listed PD-1, PD-L1, CTLA-4, and LAG-3 inhibitors.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2020-10-01Monoclonal Antibodies for the Treatment of HemophiliaDefines coverage, clinical criteria, and prior authorization requirements for monoclonal antibody therapies used as routine prophylaxis in individuals with hemophilia A or B who have moderate-to-severe disease or a high-risk bleeding phenotype.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2020-06-01Oncology Biosimilar Drug PolicyDefines preferred biosimilar formulations, prior authorization requirements, utilization management rules, and coding for specified oncology biologics across Univera Healthcare lines of business.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2020-02-24Palforzia (peanut allergen powder-dnfp) — Coverage CriteriaDefines Univera Healthcare's coverage, prior authorization, and utilization management criteria for Palforzia (peanut allergen powder-dnfp) for mitigation of allergic reactions to accidental peanut exposure; applies to multiple commercial and individual lines of business listed in the policy.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2019-12-30Duchenne Muscular Dystrophy (DMD) drug therapy coveragePharmacy management drug policy governing coverage and prior authorization criteria for multiple DMD therapies (including Agamree, Amondys 45, Duvyzat, Exondys 51, Viltepso, Vyondys 53) for Univera Healthcare lines of business.All univerahealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2019-12-01Botulinum Toxin (Botox, Daxxify, Dysport, Myobloc, Xeomin)Pharmacy management drug policy governing medical-benefit coverage, prior authorization, dosing guidance, and clinical criteria for multiple botulinum toxin products across Univera Healthcare lines of business.All univerahealthcare updates
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Tool Description
Search Univerahealthcareprior 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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