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WellFirst Health Medical Management

Authorization and coverage

Prior Authorization Services

Medical prior authorization service list

Injectables

Medical injectables list
 
Exception to coverage forms
For new FDA approved drugs on the market for less than a year that have not been reviewed or granted approval through the Pharmacy & Therapeutics Committee.
Pharmacy drug-IL
Pharmacy drug-MO
Medical injectable drug-IL
Medical injectable drug-MO
Medicare injectable drug step B therapy
Medicare pharmacy drug step B therapy

Non-covered

Non-covered services
Non-covered durable medical equipment & supplies

Information & forms

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WellFirst Health policies

  • Medical policies
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Prior authorization

  • Radiology/NIA
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Prior authorization forms

Illinois
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  • Skilled nursing facility/swing bed

Missouri
  • Behavioral health
  • Dental
  • Durable medical equipment
  • Genetic testing
  • Home health/hospice
  • Outpatient
  • Skilled nursing facility/swing bed
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