Viva Health Prior Authorization Lookup
Latest Viva Health prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Bavencio (avelumab) coverage and authorizationDefines Viva Health prior authorization, dosing limits, indications, renewal, and administration rules for intravenous avelumab (Bavencio) for oncology indications; applies to providers requesting coverage for members receiving avelumab.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Botox (onabotulinumtoxinA) — Coverage CriteriaDefines Viva Health prior-authorization, dosing limits, and medical necessity criteria for onabotulinumtoxinA (Botox) for multiple indications across intramuscular, intradetrusor, and intradermal uses; applies to providers requesting coverage for members.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Cinqair (reslizumab) IV — coverage and prior authorization criteriaClinical coverage and prior authorization criteria for intravenous reslizumab (Cinqair) for members of Viva Health, including initial and renewal requirements, dosing limits, contraindicated concomitant therapies, and billing information.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Decnupaz (pivekimab sunirine-pvzy) prior authorization and coverageDefines prior authorization, dosing limits, clinical criteria, coding, and renewal rules for intravenous Decnupaz (pivekimab sunirine-pvzy) for adults with CD123‑expressing Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN). Applies to Viva Health benefit administration.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Dysport® (abobotulinumtoxinA) — Coverage CriteriaDefines prior authorization, dosing limits, indications, and renewal criteria for Dysport (abobotulinumtoxinA) for Viva Health members receiving intramuscular, intradetrusor, or intradermal injections.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Evenity (romosozumab-aqqg) (Subcutaneous) — Coverage CriteriaDefines prior authorization, dosing limits, eligibility, and billing/coding for Evenity (romosozumab-aqqg) for treatment of osteoporosis, primarily in postmenopausal women, for Viva Health members.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Firmagon (degarelix) coverage and prior authorizationPolicy governing prior authorization, dosing, and coverage criteria for Firmagon (degarelix) for treatment of prostate cancer for Viva Health members age 18 and older.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Golimumab (Immgolis INTRI®, Simponi ARIA®) — IntravenousCoverage and prior authorization requirements for intravenous golimumab (Immgolis INTRI®, Simponi ARIA®) for indicated immune-mediated rheumatologic conditions and immune checkpoint inhibitor-related toxicities for Viva Health members.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Krystexxa (pegloticase) — Prior Authorization and Coverage CriteriaDefines prior authorization, dosing limits, initial and renewal medical necessity criteria, and billing/coding for intravenous Krystexxa (pegloticase) for members eligible under Viva Health.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Leuprolide Suspension (coverage criteria)Defines Viva Health prior authorization, dosing limits, and medical necessity criteria for leuprolide suspension formulations across multiple indications including CPP, cancer, endometriosis, fibroids, gender dysphoria, fertility preservation, and HCT-related bleeding.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Levoleucovorin (Fusilev; Khapzory) — Intravenous Coverage CriteriaDefines prior authorization, dosing limits, indications, and renewal criteria for intravenous levoleucovorin (Fusilev and Khapzory) for Viva Health members.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Libtayo (cemiplimab-rwlc) — coverage and prior authorizationDefines Viva Health medical policy coverage, dosing limits, and prior authorization requirements for intravenous cemiplimab-rwlc (Libtayo) across multiple oncology indications for adult members.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Nucala (mepolizumab) prior authorization and coverage criteriaThis policy describes prior authorization, dosing limits, initial and renewal clinical criteria, and concomitant therapy restrictions for coverage of subcutaneous mepolizumab (Nucala) for Viva Health members.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Onpattro (patisiran) intravenous therapy for hATTR polyneuropathyDefines prior authorization, dosing, approval and renewal criteria, billing codes, and coverage conditions for Onpattro (patisiran) when used to treat polyneuropathy due to hereditary transthyretin-mediated (hATTR) amyloidosis for Viva Health members.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Qalsody (tofersen) (Intrathecal) — Coverage CriteriaDefines prior authorization, dosing, eligibility, renewal, billing codes, and documentation requirements for intrathecal Qalsody (tofersen) in members with SOD1-mutant ALS under Viva Health.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Radicava (edaravone) — IntravenousThis policy governs prior authorization, dosing limits, clinical criteria, and billing for intravenous edaravone (Radicava) for treatment of amyotrophic lateral sclerosis (ALS) for Viva Health members.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Rituximab (Riabni, Rituxan, Ruxience, Truxima) Coverage CriteriaDefines prior authorization, length of authorization, dosing limits, and renewal rules for rituximab (Riabni, Rituxan, Ruxience, Truxima) for oncology and non-oncology indications for Viva Health members.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Short-Acting Granulocyte Colony Stimulating Factors (SA-G-CSF)Defines prior authorization, dosing limits, indications, and renewal criteria for short-acting G-CSF products (e.g., Filkri, Granix, Neupogen, Nivestym, Nypozi, Releuko, Zarxio) for Viva Health members.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Supprelin LA (histrelin) (Subcutaneous Implant)Policy IC-0118 defines prior authorization, dosing limits, indications, renewal criteria, and billing/coding for Supprelin LA (histrelin) implants for members of Viva Health.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Sustol (granisetron extended-release) — Coverage CriteriaCovers prior authorization, dosing, clinical criteria, and billing for Sustol (granisetron extended-release) when used for prevention of chemotherapy-induced nausea and vomiting (CINV) in Viva Health members.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Tecentriq (atezolizumab) — Coverage and Authorization PolicyDefines prior authorization, dosing limits, length of authorization, and clinical coverage criteria for intravenous atezolizumab (Tecentriq) for Viva Health members across multiple cancer indications.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Trelstar (triptorelin pamoate) (Intramuscular) — Prior authorization, dosing, and renewal criteriaThis policy defines prior authorization, dosing limits, initial approval, and renewal criteria for Trelstar (triptorelin pamoate IM) across multiple indications (e.g., prostate cancer, CPP, gender dysphoria, breast cancer, fertility preservation, uterine fibroids, head and neck cancer, uterine sarcoma) for Viva Health members.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Triptodur® (triptorelin) (Intramuscular) — Coverage CriteriaDefines Viva Health prior authorization, dosing, indications, renewal, billing codes, and clinical criteria for Triptodur® (triptorelin) intramuscular 6-month formulation for members, including pediatric central precocious puberty and gender dysphoria indications.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Waskyra (etuvetidigene autotemcel) coverage for Wiskott-Aldrich SyndromeDefines prior authorization, dosing, eligibility, and administration requirements for Waskyra (etuvetidigene autotemcel) provided to members with Wiskott-Aldrich Syndrome under Viva Health.All Viva Health updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Xeomin (incobotulinumtoxinA) coverage and authorizationDefines prior authorization, dosing limits, indications, and renewal criteria for Xeomin (incobotulinumtoxinA) for multiple intramuscular/intradetrusor/intradermal/intraglandular indications for Viva Health members.All Viva Health updates
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Tool Description
Search Viva Healthprior 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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