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Medicare Part B Prior Authorization Criteria
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Drug Name
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*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:
12/02/2024
Last Updated:
12/2024
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