Dean Advantage medical management

Pharmacy policies

Manage your medical injectable needs with:

• Medicare Part B Prior Authorization list(PDF)  
  • Policy for review criteria for prior authorizations: Medicare Prior Authorization Review when Absent NCD/LCD (PDF)
• Authorization form (PDF) updated 10/1/23

See Step B preferred and non-preferred drug lists:

• 2024 Step B Therapy Criteria (PDF) updated 4/1/24
• Step B Therapy Exception to Coverage Request (PDF) updated 10/1/23

Dean Health Plan medical policies

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, or equipment, we will use MCG (formerly Milliman Care Guidelines) criteria or our medical policy. See our Medical Services Prior Authorization List (PDF) to review medical policies relevant to the services you are requesting.

Additional information 

Explore key resources and additional information about medical management, such as:

• Radiology policies (NIA/Magellan Health)
• Mental health policies
• Musculoskeletal program (NIA/Magellan Health)