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