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.
701–750 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 |
|---|---|---|
| Tbo-filgrastim injection (Granix) | Dec 15, 2017 |
|
| Tepezza (teprotumumab-trbw) | Apr 1, 2024 |
|
| Tepezza (teprotumumab-trbw) | Not recorded |
|
|---|
| Tepezza (teprotumumab-trbw) | Not recorded |
|
|---|
| Teprotumumab-trbw (Tepezza) | Apr 1, 2023 |
|
|---|
| Teprotumumab-trbw (Tepezza) | Jun 1, 2021 |
|
|---|
| Teprotumumab-trbw (Tepezza) | Apr 1, 2022 |
|
|---|
| Teprotumumab-trbw (Tepezza) | Jun 1, 2020 |
|
|---|
| Tezepelumab-ekko (Tezspire) | May 1, 2022 |
|
|---|
| Tezepelumab-ekko (Tezspire) | May 1, 2023 |
|
|---|
| Tezspire (tezepelumab-ekko) | Not recorded |
|
|---|
| Tezspire (tezepelumab-ekko) | Apr 1, 2024 |
|
|---|
| Tezspire (tezepelumab-ekko) | Not recorded |
|
|---|
| Tildrakizumab-Asmn (Ilumya) | Oct 1, 2019 |
|
|---|
| Tildrakizumab-Asmn (Ilumya) | Nov 2, 2018 |
|
|---|
| Tildrakizumab-Asmn (Ilumya) | Aug 1, 2022 |
|
|---|
| Tildrakizumab-Asmn (Ilumya) | Aug 1, 2021 |
|
|---|
| Tildrakizumab-Asmn (Ilumya) | Jul 1, 2023 |
|
|---|
| Tildrakizumab-Asmn (Ilumya) | Sep 1, 2020 |
|
|---|
| Tobramycin inhaled products (Tobi, Tobi Podhaler, Bethkis, Kitabis Pak) | Jan 1, 2019 |
|---|
| Tobramycin inhaled products (Tobi, Tobi Podhaler, Bethkis, Kitabis Pak) | Dec 1, 2019 |
|---|
| Tocilizumab (Actemra) | Oct 1, 2021 |
|
|---|
| Tocilizumab (Actemra) | Nov 1, 2020 |
|
|---|
| Tocilizumab (Actemra) | Oct 1, 2019 |
|
|---|
| Tocilizumab (Actemra) | Nov 2, 2018 |
|
|---|
| Tocilizumab (Actemra) | Oct 1, 2022 |
|
|---|
| Tocilizumab (Actemra) | Sep 1, 2020 |
|
|---|
| Tocilizumab Intravenous (Actemra, Avtozma, Tyenne, Tofidence) non-oncology | Feb 1, 2026 |
|
|---|
| Tocilizumab Intravenous (Actemra, Tyenne, Tofidence) | Oct 1, 2024 |
|
|---|
| Tocilizumab Intravenous (Actemra, Tyenne, Tofidence) non-oncology | Oct 1, 2025 |
|
|---|
| Tremfya Intravenous (guselkumab) | Feb 1, 2025 |
|
|---|
| Tremfya Intravenous (guselkumab) | Not recorded |
|
|---|
| Tremfya Intravenous (guselkumab) | Aug 1, 2025 |
|
|---|
| Treprostinil (Remodulin) | Apr 1, 2023 |
|
|---|
| Treprostinil (Remodulin) | Jun 1, 2020 |
|
|---|
| Treprostinil (Remodulin) | Jul 1, 2019 |
|
|---|
| Treprostinil (Remodulin) | Apr 1, 2022 |
|
|---|
| Treprostinil (Remodulin) | May 1, 2021 |
|
|---|
| Treprostinil Injection (Remodulin, generic) | Mar 1, 2025 |
|
|---|
| Treprostinil Injection (Remodulin, generic) | Not recorded |
|
|---|
| Treprostinil injection (Remodulin) | Jan 1, 2019 |
|
|---|
| Tresprostinil Products(Remodulin,generic treprostinil) | Mar 1, 2024 |
|
|---|
| Triamcinolone Acetonide Extended-Release Injectable Suspension (Zilretta ) | Dec 1, 2022 |
|---|
| Triamcinolone Acetonide Extended-Release Injectable Suspension (Zilretta) | Mar 9, 2018 |
|---|
| Triamcinolone Acetonide Extended-Release Injectable Suspension (Zilretta) | Jan 1, 2021 |
|---|
| Triamcinolone Acetonide Extended-Release Injectable Suspension (Zilretta) | Dec 1, 2019 |
|---|
| Triptodur (triptorelin extended-release suspension) | Nov 1, 2025 |
|
|---|
| Triptodur (triptorelin extended-release suspension) | Nov 1, 2024 |
|
|---|
| Triptodur (triptorelin) | Nov 1, 2023 |
|
|---|
| Triptorelin Extended-Release Suspension (Triptodur) | Apr 1, 2019 |
|
|---|