CareFirst BCBS prior authorization criteria
Submission criteria, documentation packets, and P2P prep by drug — for prescribers and PA staff. 30-day standard PA decision.
CareFirst BCBS reviews prior-authorization requests against its published medical policies — diagnosis with ICD-10 code, documented step-therapy history, and prescriber attestation of medical necessity. Standard PA decisions return in 30 days; if denied, prescribers and members have 180 days to appeal. Criteria by drug below.
Prior authorization criteria by drug
Each page covers CareFirst BCBS's submission criteria, the documentation packet, and peer-to-peer prep for that drug.
- Adalimumab at CareFirst BCBS →
- Aflibercept at CareFirst BCBS →
- Apixaban at CareFirst BCBS →
- Atezolizumab at CareFirst BCBS →
- Atogepant at CareFirst BCBS →
- Benralizumab at CareFirst BCBS →
- Bevacizumab at CareFirst BCBS →
- Bictegravir at CareFirst BCBS →
- Buprenorphine at CareFirst BCBS →
- Dapagliflozin at CareFirst BCBS →
- Dulaglutide at CareFirst BCBS →
- Dupilumab at CareFirst BCBS →
- Eculizumab at CareFirst BCBS →
- Elexacaftor Tezacaftor Ivacaftor at CareFirst BCBS →
- Empagliflozin at CareFirst BCBS →
- Erenumab at CareFirst BCBS →
- Evolocumab at CareFirst BCBS →
- Faricimab at CareFirst BCBS →
- Fingolimod at CareFirst BCBS →
- Fremanezumab at CareFirst BCBS →
- Galcanezumab at CareFirst BCBS →
- Glecaprevir Pibrentasvir at CareFirst BCBS →
- Guselkumab at CareFirst BCBS →
- Ibrutinib at CareFirst BCBS →
- Imatinib at CareFirst BCBS →
- Inclisiran at CareFirst BCBS →
- Infliximab at CareFirst BCBS →
- Ixekizumab at CareFirst BCBS →
- Lenalidomide at CareFirst BCBS →
- Liraglutide at CareFirst BCBS →
- Lisdexamfetamine at CareFirst BCBS →
- Mepolizumab at CareFirst BCBS →
- Methylphenidate at CareFirst BCBS →
- Naltrexone at CareFirst BCBS →
- Natalizumab at CareFirst BCBS →
- Nintedanib at CareFirst BCBS →
- Nivolumab at CareFirst BCBS →
- Nusinersen at CareFirst BCBS →
- Ocrelizumab at CareFirst BCBS →
- Ofatumumab at CareFirst BCBS →
- Omalizumab at CareFirst BCBS →
- Ozanimod at CareFirst BCBS →
- Palbociclib at CareFirst BCBS →
- Pembrolizumab at CareFirst BCBS →
- Pirfenidone at CareFirst BCBS →
- Ribociclib at CareFirst BCBS →
- Rimegepant at CareFirst BCBS →
- Risankizumab at CareFirst BCBS →
- Rituximab at CareFirst BCBS →
- Rivaroxaban at CareFirst BCBS →
- Sacubitril Valsartan at CareFirst BCBS →
- Secukinumab at CareFirst BCBS →
- Semaglutide at CareFirst BCBS →
- Sofosbuvir at CareFirst BCBS →
- Tafamidis at CareFirst BCBS →
- Tenofovir Alafenamide at CareFirst BCBS →
- Tezepelumab at CareFirst BCBS →
- Tirzepatide at CareFirst BCBS →
- Tofacitinib at CareFirst BCBS →
- Trastuzumab at CareFirst BCBS →
- Upadacitinib at CareFirst BCBS →
- Ustekinumab at CareFirst BCBS →
Generate a CareFirst BCBS PA packet
Open ApprovalHelp — generate a prior-auth packet tailored to CareFirst BCBS's criteria, with prescriber attestation and step-therapy documentation pre-filled.
Get started →Contact: hello@approvalhelp.com