Certain procedures require preauthorization, including:
- Non-surgical outpatient cancer treatment - log in to eviti.com to enter the requested treatment. If an evidence-based treatment is selected, immediate approval is provided.
- Durable Medical Equipment (DME)/Prosthetics (DME Authorization form / Prosthetic Device Authorization form)
- Hospital inpatient care, including mental health
- Prescription drugs/Specialty drugs
- Certain radiology procedures
- Skilled nursing facility (SNF), long-term acute care (LTAC) and inpatient rehab
- Certain surgeries and procedures (Spinal Surgery Authorization form )
- Experimental/investigation surgery or treatment
- Morbid obesity surgeries
See the 2013 PCIP Plan Brochure for details.
Please note: Based on the PCIP enrollee's benefits, some medications must be obtained from Medco to avoid penalties to the member. For information about which drugs require specialty dispensing, please contact Medco at (800) 551-7675.
Other authorization forms