2026 Part D Prior Authorization Criteria

Look up your plan below to find your prior authorization criteria.

Alabama

• DEVOTED CHOICE GIVEBACK (PPO), DEVOTED DUAL CHOICE FULL (PPO D-SNP) and C-SNP Plans
• All other Alabama plans

Arizona

• DEVOTED CHOICE 001 (PPO), DEVOTED CORE 020 & 021 (HMO), DEVOTED C-SNP 023 (HMO C-SNP), DEVOTED C-SNP PLUS (HMO C-SNP), and DEVOTED C-SNP PREMIUM 024 (HMO C-SNP)
• All other Arizona plans

Arkansas

• All Arkansas plans

Colorado

• DEVOTED CHOICE 005 (PPO), DEVOTED C-SNP PLUS (HMO C-SNP), DEVOTED C-SNP PREMIUM (HMO C-SNP), and DEVOTED DUAL FULL (HMO D-SNP)
• All other Colorado plans

Delaware

• All Delaware plans

Florida

• DEVOTED CORE (HMO) 056, 057, 058, 059, 060, 061, 062, 063, 064, 065 & 066, DEVOTED C-SNP PLUS (HMO C-SNP), DEVOTED C-SNP PREMIUM (HMO C-SNP), and DEVOTED CHOICE GIVEBACK 008 (PPO)
• All other Florida plans

Georgia

• All Georgia plans

Hawaii

• DEVOTED CHOICE (PPO), DEVOTED CHOICE GIVEBACK (PPO), and DEVOTED CHOICE PREMIUM (PPO) – Honolulu and Kauai counties.
• All other Hawaii plans

Illinois

• All Illinois plans

Indiana

• All Indiana plans

Iowa

• All Iowa plans

Kansas

• All Kansas plans

Kentucky

• All Kentucky Plans

Louisiana

• All Louisiana Plans

Mississippi

• All Mississippi plans 

Missouri

• All Missouri plans 

Nebraska

• All Nebraska plans

New Mexico

• All New Mexico plans

North Carolina

• DEVOTED CORE (HMO), DEVOTED DUAL (HMO D-SNP), DEVOTED DUAL PLUS (HMO D-SNP), and DEVOTED GIVEBACK (HMO)
• All other North Carolina plans

Ohio

• DEVOTED CHOICE 003 (PPO), DEVOTED CORE 015, 019, & 022  (HMO), DEVOTED C-SNP PLUS (HMO C-SNP), and DEVOTED C-SNP PREMIUM (HMO C-SNP)
• All other Ohio plans

Oklahoma

• All Oklahoma plans

Oregon

• DEVOTED CHOICE PREMIUM 002 (PPO) and DEVOTED CORE 001 (HMO)
• All other Oregon plans

Pennsylvania

• DEVOTED CHOICE GIVEBACK 003 (PPO), DEVOTED CHOICE PREMIUM 002 (PPO), and DEVOTED CORE 023 (HMO)
• All other Pennsylvania plans.

South Carolina

• DEVOTED CHOICE (PPO), DEVOTED CHOICE GIVEBACK (PPO), DEVOTED CORE (HMO)
• All other South Carolina plans

Tennessee

• DEVOTED CHOICE 007, 010, & 015 (PPO), DEVOTED CHOICE GIVEBACK 002, 005, 006 (PPO), DEVOTED CORE (HMO), DEVOTED GIVEBACK (HMO), and DEVOTED C-SNP PREMIUM (HMO C-SNP)
• DEVOTED CHOICE 011 (PPO), DEVOTED CHOICE GIVEBACK 012 (PPO), DEVOTED C-SNP CHOICE PREMIUM (PPO C-SNP), and DEVOTED C-SNP CHOICE PLUS (PPO C-SNP)

Texas

• DEVOTED C-SNP 046 (HMO C-SNP), DEVOTED CHOICE GIVEBACK (PPO), DEVOTED CORE 003, 004, & 007 (HMO), and DEVOTED GIVEBACK 006, 008, & 048 (HMO)
• All other Texas plans

Utah

• All Utah plans

Virginia

• All Virginia Plans

Washington

• All Washington plans