Medicare Advantage PPO medical drug policies and forms

Need to treat a Medicare Advantage PPO patient with medical drugs within a provider office? You'll need to submit a prior authorization request and follow our medical policies to avoid a rejected claim. You can quickly submit your request through a web tool called NovoLogix® within Provider Secured Services.

If you already have access to Provider Secured Services, fax an Addendum P Form (PDF) to gain access to the web tool. It offers real-time status checks and immediate approvals for certain medications. 

If you don't have access to Provider Secured Services, you can submit a request for prior authorization by faxing a form found on this page.

Drugs that require prior authorization

You can find which drugs need prior authorization by viewing our Medicare Advantage PPO Medical Drug Prior Authorization List (PDF). It includes Healthcare Common Procedural Coding System, or HCPCS, codes. It also lists generic and brand names for each drug.

Looking for a generic medication authorization request form? You can submit a global request form (PDF).