Independence Blue Cross prior authorization criteria

Independence Blue Cross reviews prior-authorization requests against its published medical policies — diagnosis with ICD-10 code, documented step-therapy history, and prescriber attestation of medical necessity. The applicable product, plan terms, request type, urgency, and governing law determine the decision and appeal clocks. Confirm both in the current member-specific source and denial notice. Criteria by drug appear below.

Prior authorization criteria by drug

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

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