Pharmacy prior authorizations and exceptions

• Alabama Clinical Criteria - Effective Nov. 1, 2025open_in_new
• Alabama Clinical Criteria - Effective Oct. 1, 2025open_in_new
• Alabama Clinical Criteria - Effective Sept. 1, 2025open_in_new
• Alabama Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Arizona Clinical Criteria - Effective Nov. 1, 2025open_in_new
• Arizona Clinical Criteria - Effective Oct. 1, 2025open_in_new
• Arizona Clinical Criteria - Effective Sept. 1, 2025open_in_new
• Arizona Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Colorado Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• Colorado Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• Colorado Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• Colorado Prior Authorization Form for Prescription Benefitsopen_in_new
• Colorado Prior Authorization Form for Mental Health Step Therapy Exceptionsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Related links

• 2026 Individual Exchange Plans of Colorado Quick Reference Guideopen_in_new
• 2025 Individual Exchange Plans of Colorado Quick Reference Guideopen_in_new
• Colorado Rocky Mountain Health Plan Out-of-Network Request Formopen_in_new
• Colorado Rocky Mountain Health Plan Release of Information Formopen_in_new
• Colorado Rocky Mountain Health Plan Release of Information Form - Spanishopen_in_new
• Rocky Mountain Health Plans Administers Colorado Individual Exchange Plansopen_in_new
• Rocky Mountain Health Plans to align with UnitedHealthcare clinical requirements
• New radiation requirements for Rocky Mountain Health Plans
• UnitedHealthcare Individual Exchange Medical and Drug Policies

Pharmacy prior authorizations and exceptions

• Florida Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• Florida Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• Florida Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• Florida Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Georgia Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• Georgia Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• Georgia Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• Georgia Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Illinois Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• Illinois Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• Illinois Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• Illinois Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Indiana Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• Indiana Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• Indiana Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• Indiana Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Iowa Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• Iowa Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• Iowa Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• Iowa Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Kansas Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• Kansas Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• Kansas Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• Kansas Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Louisiana Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• Louisiana Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• Louisiana Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• Louisiana Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Maryland Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• Maryland Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• Maryland Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• Maryland Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Related links

• Maryland Health Connectionopen_in_new administers Maryland Individual Exchange Plans

Pharmacy prior authorizations and exceptions

• Massachusetts Chemotherapy and Supportive Care Prior Authorization Form open_in_new
• Massachusetts Hepatitis C Prior Authorization Formopen_in_new
• Massachusetts Prior Authorization Clinical Criteria
• Massachusetts Prior Authorization Form for Prescription Benefitsopen_in_new
• Massachusetts Specialty Pharmacy Program
• Massachusetts Step Therapy Clinical Criteria
• Notices of Changes to Prior Authorization Requirements and Coverage Criteriaopen_in_new

Related links

• Find a network pharmacyopen_in_new
• UnitedHealthcare Navigate®  administers Massachusetts Individual Exchange Plans
• Massachusetts Navigate Quick Reference Guideopen_in_new

Pharmacy prior authorizations and exceptions

• Michigan Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• Michigan Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• Michigan Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• Michigan Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Mississippi Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• Mississippi Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• Mississippi Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• Mississippi Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Missouri Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• Missouri Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• Missouri Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• Missouri Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Nebraska Clinical Criteria - Effective Nov. 1, 2025open_in_new
• Nebraska Clinical Criteria - Effective Oct. 1, 2025open_in_new
• Nebraska Clinical Criteria - Effective Sept. 1, 2025open_in_new
• Nebraska Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Related links

• Visit healthplanofnevada.comopen_in_new or sierrahealthandlife.comopen_in_new for plan options in Nevada
  

Pharmacy prior authorizations and exceptions

• New Jersey Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• New Jersey Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• New Jersey Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• New Jersey Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• New Mexico Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• New Mexico Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• New Mexico Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• New Mexico Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• New York Prior Authorization Form for Prescription Benefitsopen_in_new

Related links

• New York Compass Quick Reference Guideopen_in_new

Pharmacy prior authorizations and exceptions

• North Carolina Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• North Carolina Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• North Carolina Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• North Carolina Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Ohio Clinical Criteria - Effective Nov. 1, 2025open_in_new
• Ohio Clinical Criteria - Effective Oct. 1, 2025open_in_new
• Ohio Clinical Criteria - Effective Sept. 1, 2025open_in_new
• Ohio Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Oklahoma Clinical Criteria - Effective Nov. 1, 2025open_in_new
• Oklahoma Clinical Criteria - Effective Oct. 1, 2025open_in_new
• Oklahoma Clinical Criteria - Effective Sept. 1, 2025open_in_new
• Oklahoma Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Related links

The Centers for Medicare & Medicaid Services (CMS) Qualified Health Plan (QHP) Directory Pilot is now open. For more information, see the CMS fact sheetopen_in_new.

Pharmacy prior authorizations and exceptions

• South Carolina Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• South Carolina Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• South Carolina Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• South Carolina Prior Authorization Form for Prescription Benefitsopen_in_new 
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Tennessee Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• Tennessee Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• Tennessee Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• Tennessee Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Texas Clinical Criteria - Effective Nov. 1, 2025open_in_new
• Texas Clinical Criteria - Effective Oct. 1, 2025open_in_new
• Texas Clinical Criteria - Effective Sept. 1, 2025open_in_new
• Texas Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Related links

• 2026 Individual Exchange Plans in Texas Quick Reference Guideopen_in_new
• 2025 Individual Exchange Plans in Texas Quick Reference Guideopen_in_new

Pharmacy prior authorizations and exceptions

• Virginia Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• Virginia Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• Virginia Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• Virginia Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Washington Clinical Criteria  - Effective Nov. 1, 2025open_in_new
• Washington Clinical Criteria  - Effective Oct. 1, 2025open_in_new
• Washington Clinical Criteria  - Effective Sept. 1, 2025open_in_new
• Washington Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Related links

• Washington Healthplan Finderopen_in_new administers Washington Individual Exchange Plans

Pharmacy prior authorizations and exceptions

• Wisconsin Clinical Criteria - Effective Nov. 1, 2025open_in_new
• Wisconsin Clinical Criteria - Effective Oct. 1, 2025open_in_new
• Wisconsin Clinical Criteria - Effective Sept. 1, 2025open_in_new
• Wisconsin Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new

Pharmacy prior authorizations and exceptions

• Wyoming Clinical Criteria - Effective Nov. 1, 2025open_in_new
• Wyoming Clinical Criteria - Effective Oct. 1, 2025open_in_new
• Wyoming Clinical Criteria - Effective Sept. 1, 2025open_in_new
• Wyoming Prior Authorization Form for Prescription Benefitsopen_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Jan. 1, 2026open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Dec. 1, 2025open_in_new
• Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective Nov. 1, 2025open_in_new