Vivahealthplan Prior Authorization Lookup
Latest Vivahealthplan prior authorization updates25
- Prior AuthClinical/Medical PolicyAbraxane (paclitaxel albumin-bound) intravenous therapyThis policy governs prior authorization, dosing limits, authorization duration, and medical-necessity criteria for intravenous Abraxane (paclitaxel albumin-bound) in adult members with specified malignancies. It applies to providers requesting oncology treatment coverage under Viva Health Plan.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyAbraxane (paclitaxel albumin-bound) intravenous therapyThis policy governs prior authorization, dosing limits, authorization duration, and medical-necessity criteria for intravenous Abraxane/paclitaxel albumin-bound in adult members with specified cancers. It applies to providers requesting initial or renewed coverage for oncology treatment.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyAdzynma coverage for congenital thrombotic thrombocytopenic purpuraThis policy governs prior authorization, dosing, renewal, billing, and coverage criteria for intravenous Adzynma (recombinant ADAMTS13) used to treat congenital thrombotic thrombocytopenic purpura, including prophylactic and on-demand therapy.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyAmtagvi (lifileucel) Intravenous TherapyThis policy governs prior authorization and coverage of one treatment course of intravenous Amtagvi (lifileucel) for adults with unresectable or metastatic cutaneous melanoma. Coverage requires clinical safety, treatment-history, and documentation requirements.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyAmvuttra (vutrisiran) Coverage CriteriaThis policy governs prior authorization, medical necessity, dosing, renewal, and billing requirements for subcutaneous Amvuttra (vutrisiran) for adult members with hereditary transthyretin-mediated amyloidosis polyneuropathy or wild-type/hereditary transthyretin amyloidosis cardiomyopathy.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyAvlayah (tividenofusp alfa-eknm) Coverage CriteriaThis policy governs prior authorization and medical necessity coverage for intravenous Avlayah (tividenofusp alfa-eknm) for members with Mucopolysaccharidosis type II (Hunter syndrome). It applies to providers seeking initial or continued therapy authorization.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyBavencio (avelumab) (Intravenous) Coverage CriteriaThis policy governs prior authorization, dosing, initial approval, and renewal requirements for intravenous Bavencio (avelumab) for adult and specified pediatric members with eligible malignancies. Coverage requires indication-specific clinical criteria, and renewal requires ongoing benefit without unacceptable toxicity.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyBenlysta (belimumab) (Intravenous)This policy governs prior authorization, dosing, medical necessity, and billing requirements for intravenous Benlysta (belimumab) for members with active systemic lupus erythematosus or lupus nephritis under commercial coverage.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyBeovu (brolucizumab-dbll) intravitreal therapyThis policy governs prior authorization, dosing, renewal, and billing requirements for intravitreal Beovu in adults with neovascular age-related macular degeneration or diabetic macular edema. It applies to providers requesting coverage under Viva Health Plan.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyBerinert (C1 Esterase Inhibitor, Human) Intravenous Therapy for Acute Hereditary Angioedema AttacksThis policy governs prior authorization, medical necessity, dosing, renewal, and billing requirements for intravenous Berinert used to treat acute hereditary angioedema attacks.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyCasgevy (exagamglogene autotemcel) Coverage CriteriaPrior authorization and coverage criteria for one treatment course of Casgevy for eligible members with severe symptomatic sickle cell disease or transfusion-dependent beta thalassemia.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyCinryze (C1 Esterase Inhibitor, Human) for Hereditary Angioedema ProphylaxisThis policy governs prior authorization, coverage criteria, dosing, renewal, and billing for intravenous Cinryze used to prevent hereditary angioedema attacks for Viva Health Plan commercial members and their providers.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyCorticotropin-ACTH: Acthar Gel and Cortrophin GelThis policy governs prior authorization and medical necessity coverage for Acthar Gel and Cortrophin Gel repository corticotropin injection. Coverage is limited to specified infantile spasms and multiple sclerosis criteria, dosing limits, and renewal requirements.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyCosela (trilaciclib) Intravenous TherapyThis policy governs prior authorization and medical necessity for intravenous Cosela (trilaciclib) used to reduce chemotherapy-induced myelosuppression in adults with extensive-stage small cell lung cancer under the Viva Health Plan pharmacy benefit.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyCyramza® (ramucirumab) Intravenous CoverageThis policy governs prior authorization, medical necessity, dosing, renewal, and billing requirements for intravenous Cyramza in adult members with specified advanced or metastatic cancers. Coverage is limited to defined tumor types, treatment lines, combinations, biomarkers, prior therapies, and response or toxicity requirements.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyDawnzera (donidalorsen) for hereditary angioedema prophylaxisThis policy governs prior authorization, dosing, renewal, and billing requirements for subcutaneous Dawnzera in members seeking prophylaxis to prevent hereditary angioedema attacks. It applies to Viva Health Plan providers and requires specialist involvement, diagnostic confirmation, and documentation of clinical need.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyElahere (mirvetuximab soravtansine-gynx) for ovarian, fallopian tube, and primary peritoneal cancerThis policy governs prior authorization, dosing, initial approval, renewal, administration, and billing requirements for intravenous Elahere in adult members with specified folate receptor alpha-positive ovarian, fallopian tube, or primary peritoneal cancers. It applies to providers seeking coverage under Viva Health Plan's pharmacy and specialty drug benefit.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyElitek (rasburicase) Coverage CriteriaThis policy governs prior authorization, medical necessity, dosing, and billing requirements for intravenous Elitek (rasburicase) used to prevent or treat hyperuricemia associated with tumor lysis in Viva Health Plan members receiving chemotherapy for leukemia, lymphoma, or solid tumors.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyEmrelis (telisotuzumab vedotin-tllv) Intravenous Therapy for c-Met-Overexpressing Non-Small Cell Lung CancerPrior authorization, dosing, billing, and medical-necessity criteria for intravenous Emrelis in adult commercial members with specified recurrent, advanced, or metastatic non-squamous non-small cell lung cancer.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyEncelto™ (revakinagene taroretcel-lwey) for MacTel Type 2This policy governs prior authorization and medical-necessity coverage for Encelto administered by intravitreal implantation in adults with idiopathic macular telangiectasia type 2, including eligibility, exclusions, dosing limits, documentation, coding, and authorization duration.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyEpioxa and Epioxa HD (riboflavin 5'-phosphate) for corneal cross-linkingThis policy governs prior authorization and coverage of Epioxa and Epioxa HD for epithelium-on corneal collagen cross-linking in members with keratoconus, including one treatment dose for each affected eye.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyExdensur (depemokimab-ulaa) Coverage CriteriaThis policy governs prior authorization coverage for subcutaneous Exdensur (depemokimab-ulaa), including initial approval, renewal, dosing limits, continuation therapy, clinical eligibility, concomitant immunomodulator use, and contraindications. It applies to providers requesting Exdensur for plan members.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyFulvestrantThis policy governs prior authorization, dosing, initial approval, renewal, and administration requirements for fulvestrant products, including Faslodex, generic fulvestrant, and Cligavyx, for specified breast, ovarian, fallopian tube, primary peritoneal, endometrial, and uterine sarcoma cancers.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyFyarro (sirolimus albumin-bound) intravenous therapyThis policy governs prior authorization, coverage criteria, dosing, renewal, and billing for intravenous Fyarro in adult members with specified advanced or metastatic PEComa-related disease.All vivahealthplan updates
- Prior AuthClinical/Medical PolicyHaegarda (C1 Esterase Inhibitor Subcutaneous [Human]) Coverage CriteriaThis policy governs prior authorization, medical necessity, dosing, billing, and renewal requirements for Haegarda used to prevent hereditary angioedema attacks for Viva Health Plan members.All vivahealthplan updates
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Tool Description
Search Vivahealthplanprior 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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