Prior Authorizations forms for medical injectables drugs. See our Dean Health Plan Medicare Advantage Plans Medical Injectables List and our Medicare Advantage Authorization Form (updated 6/14/22) or our drug specific drug criteria located on the Navitus site.
Preferred and non-preferred drug list for Medical Step B injectable drugs. See our 2023 medical step B therapy criteria (updated 9/1/23) list and exception to coverage form (updated 6/14/22).
Services will be reviewed according to the Medicare Coverage Guidelines, established by the Centers for Medicare & Medicaid Services (CMS). According to the guidelines, all medical care, services, supplies and equipment must be medically necessary.
In scenarios where CMS does not provide guidance on the particular medical care, service, supplies and equipment, we will use MCG (formerly Milliman Care Guidelines) criteria or a Dean medical policy. See the our Medical Services Prior Authorization List to access the medical policies relevant to the services you are requesting.
Additional Information about medical management can be found on the Dean Health Plan medical management page. Key resources include: