Before you start searching our prior authorization tool, there are a few things you should know.
Medical or Prescription Drugs Search
Enter any medical drug or code in the search field above to see if prior authorization may be required. For example, you can search by procedure code or by service like "Cardiology." You can also search by 5-digit code, drug name or service description such as: "Avastin" or "gene analysis" or "Applied Behavior Analysis."
What To Know Before Searching
Search using the chemical, not brand, name.
If you don't search using the chemical name or generic name of your prescription, you might not find your results.
Only medicines needing prior authorization are shown.
If a medicine doesn't require prior authorization, it won't show in results. Please check that you've spelled everything correctly and used a medicine's chemical or generic name.
Some of the information is for your provider.
Some of the information included in search results, like procedure code, is to help your provider submit the prior authorization request.
Reading the Results
If your procedure needs prior authorization, you'll find it in your search results.
Each result shows in a table that includes the:
- Drug category: the type of care the drug treats
- Procedure code: used by your provider to file a prior authorization
- Drug Brand Name: the name of the medicine
- Managed by: who processes and decides the prior authorization claims
- Update History or Prior Authorization Delegation Notes: notes or effective dates about the prior authorization requirements
Here's an example of what a search result could look like.