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.
801–838 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 |
|---|---|---|
| Von Willebrand Factors (Vonvendi [von Willebrand factor {recombinant}], Wilate [von Willebrand factor/coagulation factor VIII complex {human}]) | Not recorded |
| Von Willebrand Factors (Vonvendi [von Willebrand factor {recombinant}], Wilate [von Willebrand factor/coagulation factor VIII complex {human}]) | Dec 1, 2025 |
|---|
| Vyepti (eptinezumab-jjmr) | May 1, 2025 |
|
|---|
| Vyepti (eptinezumab-jjmr) | Not recorded |
|
|---|
| Vyepti (eptinezumab-jjmr) | May 1, 2024 |
|
|---|
| Vyjuvek (beremagene geperpavec-svdt) | Nov 1, 2025 |
|
|---|
| Vyjuvek (beremagene geperpavec-svdt) | Dec 1, 2024 |
|
|---|
| Vyjuvek (beremagene geperpavec-svdt) | Feb 1, 2026 |
|
|---|
| Vyjuvek (beremagene geperpavec-svdt) | Nov 1, 2023 |
|
|---|
| Vyvgart (efgartigimod alfa-fcab injection) | Sep 1, 2023 |
|
|---|
| Vyvgart (efgartigimod alfa-fcab) Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc) | Not recorded |
|---|
| Vyvgart (efgartigimod alfa-fcab) Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc) | Dec 1, 2024 |
|---|
| Vyvgart (efgartigimod alfa-fcab) Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc) | Dec 1, 2025 |
|---|
| Xenpozyme (olipudase alfa-rpcp intravenous infusion) | Jan 1, 2026 |
|
|---|
| Xenpozyme (olipudase alfa-rpcp intravenous infusion) | Jan 1, 2025 |
|
|---|
| Xenpozyme (olipudase alfa-rpcp) | Feb 1, 2024 |
|
|---|
| Xeomin (incobotulinumtoxinA) | Not recorded |
|
|---|
| Xeomin (incobotulinumtoxinA) | Aug 1, 2024 |
|
|---|
| Xeomin (incobotulinumtoxinA) | Aug 1, 2023 |
|
|---|
| Xeomin (incobotulinumtoxinA) | Aug 1, 2025 |
|
|---|
| Xiaflex (collagenase clostridium histolyticum) | Mar 1, 2025 |
|
|---|
| Xiaflex (collagenase clostridium histolyticum) | Mar 1, 2024 |
|
|---|
| Xiaflex (collagenase clostridium histolyticum) | Not recorded |
|
|---|
| Xolair (omalizumab) | Apr 1, 2024 |
|
|---|
| Xolair (omalizumab) | Not recorded |
|
|---|
| Xolair (omalizumab) | Not recorded |
|
|---|
| Xolair (omalizumab) | Jul 1, 2024 |
|
|---|
| Zilretta (triamcinolone acetonide extended-release inject susp) | Nov 1, 2023 |
|---|
| Zilretta (triamcinolone acetonide extended-release injectable suspension) | Nov 1, 2025 |
|---|
| Zilretta (triamcinolone acetonide extended-release injectable suspension) | Nov 1, 2024 |
|---|
| Zoledronic Acid (Reclast) | Jun 1, 2017 |
|
|---|
| Zoledronic Acid (Reclast) Injection | Jul 1, 2022 |
|
|---|
| Zoledronic Acid (Reclast) Injection | Aug 1, 2021 |
|
|---|
| Zoledronic Acid (Reclast) Injection | Jan 1, 2020 |
|
|---|
| Zoledronic Acid (Reclast) Injection | Jul 1, 2023 |
|
|---|
| Zoledronic Acid (Reclast) Injection | Sep 1, 2020 |
|
|---|
| Zoledronic Acid (Reclast) Injection | Mar 1, 2019 |
|
|---|
| Zoledronic Acid (Zometa) | Jun 1, 2017 |
|
|---|