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. 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 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 →