New-to-Market drug list
For most benefits, there is an evaluation period before adding new, FDA-approved brand-name prescription drugs to the formulary or to medical coverage. During this time, the drug will be considered non-covered while the Wellmark P&T Committee reviews the clinical evidence available.
If it is determined that a drug should be covered and managed through medical policy or prior authorization, the policy and the drug will be added to the medical authorization table or drug authorization list. The formulary will also be updated.
Important: A new medication or a new FDA-approved use for an existing medication will remain non-covered for up to six months while reviews and coding updates are completed.
Download the current drug list of new-to-market, non-covered medications
Review the New to Market Drug policy
View information for biosimilars within our member resources.
New drug approval process
Learn how newly approved medications are reviewed for coverage and when they may be added to the formulary.
For most health plans, new medications go through a review before they are added to the formulary or covered under the medical benefit. During this review, the medication is non-covered while the Wellmark Pharmacy & Therapeutics (P&T) Committee reviews the clinical evidence. The committee then decides if the drug will have any coverage or management rules.
This process applies to all FDA-approved brand-name drugs and some biosimilar and generic drugs. When the review is complete and a coverage decision is made, the formulary or medical coding will be updated as needed. New medications remain non-covered until both the review and coding updates are complete.
Drugs that follow this process are added to the New-to-Market Drug List after FDA approval.
New indication process
Learn how new FDA-approved uses for existing medications are reviewed before coverage decisions are made.
When the FDA approves a new use for an existing medication and there is already a policy in place, that policy will keep the medication under review until either a P&T or business review is completed.
If an existing medication does not have a policy and receives a new FDA-approved use, that medication may also remain under review until a P&T review or a business review is completed.
In either case, the medication will not be covered for the new use while it is under review.
Individual consideration process
Learn how providers can request individual consideration for eligible medications under review.
Some new medications or new FDA-approved uses may qualify for an individual consideration review before Wellmark finalizes its coverage review and sets utilization requirements.
This option is available for medications that:
- Address an unmet medical need for a serious or life-threatening condition
- Do not have major safety or effectiveness concerns
Your provider can request this review if delaying treatment could:
- Cause a serious decline in your health
- Jeopardize your ability to regain maximum function
- Become life-threatening
Requests are reviewed based on:
- Your specific health plan benefits
- Coverage eligibility
- Medical necessity
Our medical necessity review may include:
- Wellmark drug policies
- FDA-approved labeling
- Clinical trial criteria
- Drug compendia (when available)
- Current evidence-based standards of care
How to submit
Providers can send clinical details to:
Wellmark Pharmacy Department
1331 Grand Ave
Des Moines, IA 50309
Processes last reviewed in October 2025 and effective Oct. 28, 2025.
Manage medical and drug authorizations
Some medical services, procedures, durable medical equipment (DME) and drugs require approval before they can be covered by your patients' benefits.
Upon receiving approval, you will be given an authorization number. Please reference this number on all claims related to the specific procedure or service requiring prior approval. Also, remember that services determined as not medically necessary, investigational or experimental are the liability of the provider.
Jiva
Submit prior authorization requests electronically with Jiva, Wellmark’s medical authorization tool.
Log in to the Wellmark Provider Portal to view frequently asked questions and user guides with step-by-step instructions for submitting authorizations.
- Acute rehab
- Extending stay requests
- Inpatient
- Out-of-network
- Outpatient
- Physical medicine
- Residential inpatient
- Skilled nursing facility
InterQual®
Access InterQual review criteria and training resources for clinical and inpatient reviews.
Novologix®
Submit and manage drug authorization requests with Novologix, Wellmark's pharmacy authorization tool.
Related links
- Imaging services pre-authorization code groupings
- Types of authorizations
- InterQual® Criteria and SmartSheetsTM
- Prior approval for Federal Employee Program (FEP) Members
- Humira biosimilar strategy FAQ
- Utilization management-related webinars
- View important details about authorizations
- Inpatient review FAQ
Disclosures
EviCore® by Evernorth is an independent company that simplifies and automates the prior authorization process on behalf of Wellmark.
Wellmark Blue Cross and Blue Shield uses Jiva to help manage medical authorizations. Jiva is a product of ZeOmega, a separate company offering population health management tools for insurers and health plans.
Novologix® is a registered trademark of CVS Health, providing a technology platform to support prior authorization and utilization management for specialty and medical benefit drugs on behalf of Wellmark.