Healthfirst prior authorization criteria

Healthfirst 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 60 days to appeal. Criteria by drug below.

Prior authorization criteria by drug

Each page covers Healthfirst's submission criteria, the documentation packet, and peer-to-peer prep for that drug.

• Adalimumab at Healthfirst →
• Aflibercept at Healthfirst →
• Apixaban at Healthfirst →
• Atezolizumab at Healthfirst →
• Atogepant at Healthfirst →
• Benralizumab at Healthfirst →
• Bevacizumab at Healthfirst →
• Bictegravir at Healthfirst →
• Buprenorphine at Healthfirst →
• Dapagliflozin at Healthfirst →
• Dulaglutide at Healthfirst →
• Dupilumab at Healthfirst →
• Eculizumab at Healthfirst →
• Elexacaftor Tezacaftor Ivacaftor at Healthfirst →
• Empagliflozin at Healthfirst →
• Erenumab at Healthfirst →
• Evolocumab at Healthfirst →
• Faricimab at Healthfirst →
• Fingolimod at Healthfirst →
• Fremanezumab at Healthfirst →
• Galcanezumab at Healthfirst →
• Glecaprevir Pibrentasvir at Healthfirst →
• Guselkumab at Healthfirst →
• Ibrutinib at Healthfirst →
• Imatinib at Healthfirst →
• Inclisiran at Healthfirst →
• Infliximab at Healthfirst →
• Ixekizumab at Healthfirst →
• Lenalidomide at Healthfirst →
• Liraglutide at Healthfirst →
• Lisdexamfetamine at Healthfirst →
• Mepolizumab at Healthfirst →
• Methylphenidate at Healthfirst →
• Naltrexone at Healthfirst →
• Natalizumab at Healthfirst →
• Nintedanib at Healthfirst →
• Nivolumab at Healthfirst →
• Nusinersen at Healthfirst →
• Ocrelizumab at Healthfirst →
• Ofatumumab at Healthfirst →
• Omalizumab at Healthfirst →
• Ozanimod at Healthfirst →
• Palbociclib at Healthfirst →
• Pembrolizumab at Healthfirst →
• Pirfenidone at Healthfirst →
• Ribociclib at Healthfirst →
• Rimegepant at Healthfirst →
• Risankizumab at Healthfirst →
• Rituximab at Healthfirst →
• Rivaroxaban at Healthfirst →
• Sacubitril Valsartan at Healthfirst →
• Secukinumab at Healthfirst →
• Semaglutide at Healthfirst →
• Sofosbuvir at Healthfirst →
• Tafamidis at Healthfirst →
• Tenofovir Alafenamide at Healthfirst →
• Tezepelumab at Healthfirst →
• Tirzepatide at Healthfirst →
• Tofacitinib at Healthfirst →
• Trastuzumab at Healthfirst →
• Upadacitinib at Healthfirst →
• Ustekinumab at Healthfirst →