Medical Policies and Coverage


Effective March 15, 2022, medical drug policies will permanently move from this page to the Prior Review and Limitations page. Please submit all requests for the affected medical drugs via the CMM Portal or fax to 1-888-348-7332. For additional information, please view additional updates on the medical drug review process transition.

Medical Policies

Search for medical policies and guidelines and get policy updates.

Prior Review

Find prior review, or prior plan approval, requirements and instructions for requesting prior review

Important information regarding medical necessity reviews


See instructions for filing an appeal and get answers to frequently asked questions.

Medical Policy and Pre-certification/Pre-authorization Information for Out-of-Area Members

Search requirements for BlueCard® eligible members