Pharmacy Clinical Policies | Resources | Prior Authorization List

PreferredOne updates its clinical policies and prior authorization (PA) list regularly and reserves the right to amend the prior authorization list and/or policies at any time. If material amendments are made to any policy or PA list, PreferredOne will disclose this information to contracted healthcare providers no less than 45 days prior to the implementation of any new or updated policy or PA list changes. PreferredOne reserves the right to amend non-material updates to the PA list or any policy at any time without disclosure. Click on the “Medical Policy and Pharmacy Policy Future Updates” link to the right for the latest updates.

Effective July 1, 2021- PreferredOne will be implementing a pre-payment, post service edit program on specific medically administered medications. For a complete list of medications that will be impacted, click here.

Aspirus Health Plan updates its clinical policies and prior authorization (PA) list regularly and reserves the right to amend the prior authorization list and/or policies at any time. If material amendments are made to any policy or PA list, Aspirus Health Plan will disclose this information to contracted healthcare providers no less than 45 days prior to the implementation of any new or updated policy or PA list changes. Aspirus Health Plan reserves the right to amend non-material updates to the PA list or any policy at any time without disclosure.

Effective August 1, 2021- A pre-payment, post service claims edit program on specific medically administered medications will be implemented. For a complete list of medications that will be impacted, click here.

Important note: Before using these policies, read Coverage Policy Usage Notice.

Before services are rendered, read Prior Authorization List & Policy Usage Notice, Site of Care Policy Information.

Before services are rendered, read Prior Authorization List & Policy Usage Notice.

*Site of Care Criteria Applies (PC/S009) Site of Care List.pdf

Prior Authorization Drug List