Commercial Plans
Timelines for submitting requests and response times
2022 Prior Authorization Lists
General
Commercial Membership (Fully Insured)
Individual and Family Plans and Small Group ACA
Health Insurance Exchange
State of Wisconsin (ETF)
Self-Insured Assure Plans
Self-Insured Horizon and Network Health
Pharmacy
ESI Care Continuum Prior Authorization Drug List
August 2022
September 2022
Prior Authorization Drug List
Authorization List for Step Therapy Drugs
Genetic Testing
Genetic Testing Authorization Resources
Experimental or Investigative
For the most up-to-date Experimental and Investigational Authorization List,
please contact us at 800-826-0940, Monday, Wednesday, Thursday and
Friday from 8 a.m. to 5 p.m., and Tuesdays from 8 a.m. to 4 p.m.
2021 Prior Authorization Lists
General
Commercial Membership (Fully Insured)
Individual and Family Plans and Small Group ACA
Health Insurance Exchange
State of Wisconsin (ETF)
Self-Insured Assure Plans
Self-Insured Horizon and Network Health