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