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Prior Authorization

As of Monday, October 24, 2022, HPP will begin to use Interqual 2022 criteria.

“Prior Authorization” is a term used for select services (e.g., homecare services), items (e.g., Durable Medical Equipment purchases over $500) and prescriptions for some injectable or infusion drugs (e.g., Botox, Soliris, OxyContin) that must be pre-approved by Health Partners Plans. Prior Authorizations are sometimes referred to as “preauthorizations” or “precertifications” – they mean the same thing.

Note: Health Partners Plans requires prior authorizations for select services performed in an outpatient setting, including those performed in the office, short procedure units, ambulatory surgery centers, clinics, and hospital outpatient departments.

Prior Authorization Guidelines

Our Prior Authorization Guidelines provide an up-to-date list of all services requiring prior authorization. In additon, our medical drugs list is updated frequently.

Pharmacy Prior Authorization Request Forms

If you want to request a non-formulary drug or a formulary drug that requires prior authorization, please use the appropriate forms as indicated below.

Health Partners (Medicaid), KidzPartners (CHIP)

Health Partners Medicare

  • Drug-Specific Prior Authorization Forms — Use the appropriate request form to help ensure that all necessary information is provided for the requested drug
  • Fax all completed Health Partners Medicare prior authorization request forms to 1-866-371-3239.