Important NPL updates
The following new-to-market drugs require precertification:
The following drugs will require precertification, including Part B step therapy review, effective January 1, 2020, for Medicare Advantage members only:
We encourage you to submit precertification requests at least two weeks before the scheduled services.
To save time, request precertification electronically — it’s fast and simple. Most precertification requests can be submitted electronically through the provider website or by using your Electronic Medical Record (EMR) system portal.
You can find more information about precertification under the General Information section of the NPL.
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Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Do you want to continue?
