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New-to-market drugs

For most benefits, there is an evaluation period before adding new, FDA-approved brand-name prescription drugs to the formulary or to medical coverage after the prescription drug receives an FDA approval. During this evaluation period, the drug will be considered non-covered while the Wellmark Pharmacy & Therapeutics (P&T) Committee reviews the clinical evidence available, including but not limited to, the drug’s safety, efficacy, and place in therapy.

If, following the P&T evaluation, 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.

Refer to our complete list of new-to-market non-covered medications PDF File

Medical authorizations

The medical authorization table provides the medical policies and criteria used by Wellmark and is the first stop in learning whether an authorization is required.

Be sure to obtain approval in advance to help prevent delays and unexpected costs.

Verify authorization

View Authorization Table Search Out-of-Area Authorizations

Submit or check authorization or view status

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Drug authorizations

Some drugs, and certain amounts of some drugs, require an approval before they are eligible for coverage. The drugs listed below require prior authorization.

Click the drug name or policy name to view the clinical criteria.

Verify authorization

View Drug Authorization List

Submit authorization or view status

Submit Drug Authorizations Secure Site Check Authorization Status Drug Authorization Secure Site

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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.