1,169 code entries across 838 active EviCore by Evernorth policies that Backwork has recorded as requiring prior authorization. Each policy links to its page and to the payer’s source.
Summary of the payer’s published policy. Not a coverage determination — confirm with EviCore by Evernorth before submitting.
601–650 of 838, by title
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Policy | Effective | Codes requiring prior authorization |
|---|---|---|
| Remdesivir (Veklury) | Jun 1, 2022 |
|
| Repository corticotropin injection (Purified Cortrophin Gel) | Apr 1, 2022 |
|
| Repository corticotropin injection (Purified Cortrophin Gel) | Mar 1, 2023 |
|
|---|
| Reslizumab (Cinqair) | Jul 1, 2020 |
|
|---|
| Reslizumab (Cinqair) | May 1, 2023 |
|
|---|
| Reslizumab (Cinqair) | Jun 1, 2021 |
|
|---|
| Reslizumab (Cinqair) | Jan 1, 2019 |
|
|---|
| Reslizumab (Cinqair) | May 1, 2022 |
|
|---|
| Reslizumab (Cinqair) | Aug 1, 2019 |
|
|---|
| RiaSTAP (fibrinogen concentrate [human]) Fibryga (fibrinogen concentrate [human]) | Nov 1, 2024 |
|---|
| RimabotulinumtoxinB (Myobloc) | Sep 1, 2021 |
|
|---|
| RimabotulinumtoxinB (Myobloc) | Aug 1, 2022 |
|
|---|
| RimabotulinumtoxinB (Myobloc) | Jun 1, 2017 |
|
|---|
| RimabotulinumtoxinB (Myobloc) | Oct 1, 2020 |
|
|---|
| RimabotulinumtoxinB (Myobloc) | Mar 1, 2019 |
|
|---|
| RimabotulinumtoxinB (Myobloc) | Jan 1, 2019 |
|
|---|
| RimabotulinumtoxinB (Myobloc) | Sep 1, 2019 |
|
|---|
| Rituximab (Rituxan, Ruxience, Truxima, Riabni) | Jul 1, 2023 |
|
|---|
| Rituximab (Rituxan, Ruxience, Truxima, Riabni) | Not recorded |
|
|---|
| Rituximab (Rituxan, Ruxience, Truxima, Riabni) | Not recorded |
|
|---|
| Rituximab (Rituxan, Ruxience, Truxima, Riabni) | Jul 1, 2021 |
|
|---|
| Rituximab (Rituxan, Ruxience, Truxima, Riabni) | Jul 1, 2022 |
|
|---|
| Rituximab (Rituxan, Ruxience, Truxima, Riabni)_Non-oncology | Jun 1, 2024 |
|
|---|
| Rituximab (Rituxan, Ruxience, Truxima) | Sep 1, 2020 |
|
|---|
| Rituximab (Rituxan) | Nov 2, 2018 |
|
|---|
| Rituximab (Rituxan) | Sep 1, 2019 |
|
|---|
| Romiplostim (Nplate) | Jan 1, 2019 |
|
|---|
| Romiplostim (Nplate) | Jun 1, 2020 |
|
|---|
| Romiplostim (Nplate) | Apr 1, 2022 |
|
|---|
| Romiplostim (Nplate) | Jun 1, 2021 |
|
|---|
| Romiplostim (Nplate) | Jul 1, 2019 |
|
|---|
| Romiplostim (Nplate) | Apr 1, 2023 |
|
|---|
| Romosozumab-aqqg (Evenity) | Jul 1, 2023 |
|
|---|
| Romosozumab-aqqg (Evenity) | Aug 1, 2021 |
|
|---|
| Romosozumab-aqqg (Evenity) | Sep 1, 2020 |
|
|---|
| Romosozumab-aqqg (Evenity) | Aug 1, 2019 |
|
|---|
| Romosozumab-aqqg (Evenity) | Jul 1, 2022 |
|
|---|
| Ruconest (recombinant C1 esterase inhibitor) | Jan 1, 2026 |
|
|---|
| Ruconest (recombinant C1 esterase inhibitor) | Feb 1, 2024 |
|
|---|
| Ruconest (recombinant C1 esterase inhibitor) | Dec 1, 2024 |
|
|---|
| Rystiggo (rozanolixizumab-noli) | Dec 1, 2023 |
|
|---|
| Rystiggo (rozanolixizumab-noli) | Dec 1, 2024 |
|
|---|
| Rystiggo (rozanolixizumab-noli) | Dec 1, 2025 |
|
|---|
| Sandostatin LAR Depot (octreotide acetate) for Injectable Suspension and Sandostatin (octreotide acetate) Injection | May 1, 2024 |
|---|
| Saphnelo (anifrolumab-fnia) | Not recorded |
|
|---|
| Saphnelo (anifrolumab-fnia) | Jul 1, 2024 |
|
|---|
| Saphnelo (anifrolumab-fnia) | Mar 1, 2024 |
|
|---|
| Saphnelo (anifrolumab-fnia) | Jul 1, 2025 |
|
|---|
| Sargramostim (Leukine) | Dec 1, 2018 |
|
|---|
| Sevenfact (coagulation factor VIIa [recombinant]-jncw) | Nov 1, 2024 |
|
|---|