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.
- Prior Authorization Management Tools (updated 12/9/22)
- Medical Drugs That Require Prior Authorization (Medicaid and CHIP) (Excel; updated 7/12/22)
- Medical Drugs That Require Prior Authorization (Medicare)
- Medical Oncology Supportive Drugs - eviCore (Excel; updated 1/1/23)
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)
- Drug-Specific Prior Authorization Forms (2023) — Use the appropriate request form to help ensure that all necessary information is provided for the requested drug.
- Drug-Specific Prior Authorization Forms (2022) — Use the appropriate request form to help ensure that all necessary information is provided for the requested drug.
- Non-Formulary Drug Prior Authorization Form — Use this request form if the medication you want to request does not have an associated drug-specific form.
- Fax all completed Health Partners (Medicaid) and KidzPartners (CHIP) prior authorization request forms to 1-866-240-3712.
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.