Health Care Service Corporation · Prior auth
Health Care Service Corporation prior authorization criteria
Submission criteria, documentation packets, and P2P prep by drug — for prescribers and PA staff. 30-day standard PA decision.
Standard PA decision
30 days
Appeal window if denied
180 days
Drugs covered
62
Health Care Service Corporation 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 Health Care Service Corporation's submission criteria, the documentation packet, and peer-to-peer prep for that drug.
- Adalimumab at Health Care Service Corporation →
- Aflibercept at Health Care Service Corporation →
- Apixaban at Health Care Service Corporation →
- Atezolizumab at Health Care Service Corporation →
- Atogepant at Health Care Service Corporation →
- Benralizumab at Health Care Service Corporation →
- Bevacizumab at Health Care Service Corporation →
- Bictegravir at Health Care Service Corporation →
- Buprenorphine at Health Care Service Corporation →
- Dapagliflozin at Health Care Service Corporation →
- Dulaglutide at Health Care Service Corporation →
- Dupilumab at Health Care Service Corporation →
- Eculizumab at Health Care Service Corporation →
- Elexacaftor Tezacaftor Ivacaftor at Health Care Service Corporation →
- Empagliflozin at Health Care Service Corporation →
- Erenumab at Health Care Service Corporation →
- Evolocumab at Health Care Service Corporation →
- Faricimab at Health Care Service Corporation →
- Fingolimod at Health Care Service Corporation →
- Fremanezumab at Health Care Service Corporation →
- Galcanezumab at Health Care Service Corporation →
- Glecaprevir Pibrentasvir at Health Care Service Corporation →
- Guselkumab at Health Care Service Corporation →
- Ibrutinib at Health Care Service Corporation →
- Imatinib at Health Care Service Corporation →
- Inclisiran at Health Care Service Corporation →
- Infliximab at Health Care Service Corporation →
- Ixekizumab at Health Care Service Corporation →
- Lenalidomide at Health Care Service Corporation →
- Liraglutide at Health Care Service Corporation →
- Lisdexamfetamine at Health Care Service Corporation →
- Mepolizumab at Health Care Service Corporation →
- Methylphenidate at Health Care Service Corporation →
- Naltrexone at Health Care Service Corporation →
- Natalizumab at Health Care Service Corporation →
- Nintedanib at Health Care Service Corporation →
- Nivolumab at Health Care Service Corporation →
- Nusinersen at Health Care Service Corporation →
- Ocrelizumab at Health Care Service Corporation →
- Ofatumumab at Health Care Service Corporation →
- Omalizumab at Health Care Service Corporation →
- Ozanimod at Health Care Service Corporation →
- Palbociclib at Health Care Service Corporation →
- Pembrolizumab at Health Care Service Corporation →
- Pirfenidone at Health Care Service Corporation →
- Ribociclib at Health Care Service Corporation →
- Rimegepant at Health Care Service Corporation →
- Risankizumab at Health Care Service Corporation →
- Rituximab at Health Care Service Corporation →
- Rivaroxaban at Health Care Service Corporation →
- Sacubitril Valsartan at Health Care Service Corporation →
- Secukinumab at Health Care Service Corporation →
- Semaglutide at Health Care Service Corporation →
- Sofosbuvir at Health Care Service Corporation →
- Tafamidis at Health Care Service Corporation →
- Tenofovir Alafenamide at Health Care Service Corporation →
- Tezepelumab at Health Care Service Corporation →
- Tirzepatide at Health Care Service Corporation →
- Tofacitinib at Health Care Service Corporation →
- Trastuzumab at Health Care Service Corporation →
- Upadacitinib at Health Care Service Corporation →
- Ustekinumab at Health Care Service Corporation →
Generate a Health Care Service Corporation PA packet
Open ApprovalHelp — generate a prior-auth packet tailored to Health Care Service Corporation's criteria, with prescriber attestation and step-therapy documentation pre-filled.
Get started →Contact: hello@approvalhelp.com