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Prior Authorization Summary 2021
  • 2021 Q4 Summary PDF
    2021 Q4 Summary Eform
    2021 Q4 Summary Link
  • 2021 Q3 Summary PDF
    2021 Q3 Summary Eform
    2021 Q3 Summary Link
  • 2021 Q2 Summary PDF
    2021 Q2 Summary Eform
    2021 Q2 Summary Link
  • 2021 Q1 Summary PDF
    2021 Q1 Summary Eform
    2021 Q1 Summary Link

Prior Authorization Summary 2020
  • 2020 Q4 Summary PDF
    2020 Q4 Summary Eform
    2020 Q4 Summary Link
  • 2020 Q3 Summary PDF
    2020 Q3 Summary Eform
    2020 Q3 Summary Link
  • 2020 Q2 Summary PDF
    2020 Q2 Summary Eform
    2020 Q2 Summary Link
  • 2020 Q1 Summary PDF
    2020 Q1 Summary Eform
    2020 Q1 Summary Link

Prior Authorization Summary 2019
  • 2019 Q4 Summary PDF
    2019 Q4 Summary Eform
    2019 Q4 Summary Link
  • 2019 Q3 Summary PDF
    2019 Q3 Summary Eform
    2019 Q3 Summary Link
  • 2019 Q2 Summary PDF
    2019 Q2 Summary Eform
    2019 Q2 Summary Link
  • 2019 Q1 Summary PDF
    2019 Q1 Summary Eform
    2019 Q1 Summary Link

For United Healthcare clinical criteria, please click on this link:

https://www.uhcprovider.com/en/resource-library/drug-lists-pharmacy.html

 

For QualChoice clinical criteria, please click on the link below:

https://documents.qualchoice.com/area/shared/medicalpolicies.aspx?ShowLinks=1

 

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