Prior Authorizations
Certain services, items and prescriptions for some injectable or infusion drugs must be pre-approved. Prior Authorizations are also sometimes referred to as “preauthorizations” or “precertifications.”
Medical drugs that require prior authorization include:
Our prior authorization guidelines provide an up-to-date list of all services requiring prior authorization. Prior authorizations are processed either through our provider portal or eviCore. Check out our prior authorization management tool to identify which services require submission through the provider portal or eviCore:
Prior Authorizations for both formulary and non-formulary drugs can now be completed online. You may also continue to use the appropriate forms listed below.
Health Partners Plans Medicaid and CHIP
- Drug-Specific Prior Authorization Forms — 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 these request forms if the medication you want to request does not have an associated drug-specific form.
Fax all completed Medicaid and CHIP prior authorization request forms to 1-866-240-3712.
Jefferson Health Plans Medicare Advantage
- Drug-Specific Prior Authorization Forms — Use the appropriate request form to help ensure that all necessary information is provided for the requested drug.
- Prescription Drug Coverage Determination Request Form
Fax all completed Medicare Advantage prior authorization request forms to 1-866-371-3239.
Jefferson Health Plans Individual and Family Plans
- Find the information that you need, including how to request a prior authorization here: Prior Authorizations.