Choice Products Northwest
Kaiser Permanente Northwest Choice Products
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Member Information

Prior Authorization Approval

To ensure that the medical service ordered is medically necessary, prior authorization approval may be required. This is known as prior authorization for services ordered by a select provider, PPO provider, or non-participating provider.

What requires prior authorization?

Select Provider Tier

Kaiser Permanente Providers

  • For care with Kaiser Permanente providers, your provider will arrange for prior authorization, if required, for certain services.

PPO provider tier

Drugs requiring prior authorization

Certain drugs filled at MedImpact pharmacies may be subject to prior authorization. For a list of restricted drugs and the criteria used, see below. For further information on these restrictions please see your Evidence of Coverage.

Actemra – Criteria (PDF)

Aranesp – Criteria (PDF)

Auvi-Q – Criteria (PDF)

Avonex – Criteria (PDF)

Berinert – Criteria (PDF)

Betaseron – Criteria (PDF)

Cimzia – Criteria (PDF)

Cinryze – Criteria (PDF)

Copaxone – Criteria (PDF)

Cystaran – Criteria (PDF)

Daklinza – Criteria (PDF)

Dupixent – Criteria (PDF)

Emflaza – Criteria (PDF)

Enbrel – Criteria (PDF)

Epclusa – Criteria (PDF)

Epogen – Criteria (PDF)

Esbriet – Criteria (PDF)

Evzio – Criteria (PDF)

Extavia – Criteria (PDF)

Firazyr – Criteria (PDF)

Fortamet – Criteria (PDF)

Genotropin – Criteria (PDF)

Gilenya – Criteria (PDF)

Glatopa – Criteria (PDF)

Glumetza – Criteria (PDF)

Granix – Criteria (PDF)

Harvoni – Criteria (PDF)

HP Acthar – Criteria (PDF)

Humatrope – Criteria (PDF)

Humira – Criteria (PDF)

Juxtapid – Criteria (PDF)

Kalydeco – Criteria (PDF)

Kineret – Criteria (PDF)

Kuvan – Criteria (PDF)

Kynamro – Criteria (PDF)

Mircera – Criteria (PDF)

Neulasta – Criteria (PDF)

Neupogen – Criteria (PDF)

Norditropin – Criteria (PDF)

Nutropin – Criteria (PDF)

Ofev – Criteria (PDF)

Omnitrope – Criteria (PDF)

Orencia – Criteria (PDF)

Orenitram – Criteria (PDF)

Orfadin – Criteria (PDF)

Orkambi – Criteria (PDF)

Oxycontin – Criteria (PDF)

Plegridy – Criteria (PDF)

Praluent – Criteria (PDF)

Procrit – Criteria (PDF)

Pulmozyme – Criteria (PDF)

Rebif – Criteria (PDF)

Remodulin – Criteria (PDF)

Repatha – Criteria (PDF)

Ruconest – Criteria (PDF)

Saizen – Criteria (PDF)

Serostim – Criteria (PDF)

Simponi – Criteria (PDF)

Sovaldi/Olysio – Criteria (PDF)

Stelara – Criteria (PDF)

Tecfidera – Criteria (PDF)

Technivie – Criteria (PDF)

Tyvaso – Criteria (PDF)

Viekira – Criteria (PDF)

Xeljanz – Criteria (PDF)

Xyrem – Criteria (PDF)

Zarxio – Criteria (PDF)

Zepatier – Criteria (PDF)

Zomacton – Criteria (PDF)

Zorbtive – Criteria (PDF)

 

First Choice Health Network or First Health Network

  • For participating providers, some services, such as inpatient care (for example, hospital surgical procedures) and some outpatient procedures, require prior authorization to be covered.

How do I receive prior authorization?

  • Your participating provider will obtain prior authorization for you.
  • To learn more, review the prior authorization section in your Evidence of Coverage (EOC) for details.

Non-participating provider tier

Any other licensed provider or physician

  • For non-participating providers, some services, such as inpatient care (for example, hospital surgical procedures) and some outpatient procedures, require prior authorization to be covered.

 How do I receive prior authorization?

  • Your non-participating provider may obtain prior authorization for you or your authorized representative by calling 1-855-281-1840 (TTY 711).
  • If you don’t obtain prior authorization for services in the non-participating provider tier, you may have to pay the entire expense. The penalty does not apply toward your deductible or out-of-pocket maximum, so it is important to get prior authorization before receiving these services.
  • To learn more, review the prior authorization section in your Evidence of Coverage (EOC) for details.

Need prior authorization or have questions about it?

Call 1-855-281-1840 (TTY 711).