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