Priority Health prior authorization criteria

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. 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 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 →