Effective July 1, 2023: Medicare Prior Authorization Requirements

Date: 05/30/23

Wellcare By Allwell (HMO and HMO SNP) requires prior authorization as a condition of payment for many services. This notice contains information regarding these prior authorization requirements and is applicable to all Medicare products offered by Wellcare.

Wellcare is committed to delivering cost effective quality care to members. This effort requires us to ensure that members receive only treatment that is medically necessary according to current standards of practice.

Effective July 1, 2023, prior authorization will be required for certain services on the Medicare Prior Authorization List – Effective July 1, 2023 (PDF), and will also be available on the Medicare Prior Authorization Tool webpage.

Additionally, Wellcare’s Medicare Part B Drugs List has also been updated. Please review this listing for the latest Part B drugs that require utilization review, effective July 1, 2023. To find a list of Medicare Part B List of Drugs Requiring Prior Authorization, please visit the Medicare Advantage Pharmacy Resources section of Superior’s Pharmacy webpage.

Please note: Prior authorization is a process initiated by the ordering physician in which we verify the medical necessity of a treatment in advance using independent objective medical criteria. It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization. Prior authorization is subject to covered benefit review and is not a guarantee of payment.

For questions, please contact Provider Services at 1-877-391-5921.