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Medicare Part B Prior Authorization Criteria

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Therapeutic Class Search Skip to Footer

  • *Analgesics - Anti-Inflammatory*
  • *Androgens-Anabolic*
  • *Antiasthmatic And Bronchodilator Agents*
  • *Antidiabetics*
  • *Antihyperlipidemics*
  • *Antineoplastics And Adjunctive Therapies*
  • *Antivirals*
  • *Cardiovascular Agents - Misc.*
  • *Dermatologicals*
  • *Diagnostic Products*
  • *Endocrine And Metabolic Agents - Misc.*
  • *Gastrointestinal Agents - Misc.*
  • *Genitourinary Agents - Miscellaneous*
  • *Gout Agents*
  • *Hematological Agents - Misc.*
  • *Hematopoietic Agents*
  • *Migraine Products*
  • *Miscellaneous Therapeutic Classes*
  • *Musculoskeletal Therapy Agents*
  • *Neuromuscular Agents*
  • *Ophthalmic Agents*
  • *Passive Immunizing And Treatment Agents*
  • *Psychotherapeutic And Neurological Agents - Misc.*
  • *Respiratory Agents - Misc.*
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*Please note: CMS may have policies (e.g. NCDs, LCDs) that preclude the Part B drug criteria contained in this document
Id: 24445
Plan Year: 04/21/2025
Last Updated:
04/2025

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