QP21-26 Updated Forms and Processes for Prior Authorization Requests

Report to the Community

2025 Interoperability Report

Medicare prior authorization requests and responses from 1/1/2025 through 12/31/2025

Primary Biliary Cholangitis - Medicaid

Prior Authorization, Quantity Limit

Primary Biliary Cholangitis - Commercial

Prior Authorization, Quantity Limit

Supply Code List

DME Code List

Dry Eye Disease - Commercial

Prior Authorization, Quantity Limit

DPP-4 Inhibitors and Combinations - Commercial

Step Therapy, Quantity Limit

Biologic Immunomodulators - BasicRx (For Pharmacy Benefits Only) - Commercial

Prior Authorization, Quantity Limit