Prior authorization reporting

• Prior authorization reporting (PDF)

We received 46,105 prior authorization requests in 2025:

• 35,830 requests were submitted electronically, and 10,275 requests were not submitted electronically.
• 38,340 requests were approved, and 7,765 requests were denied.

Of the 7,765 prior authorization requests we denied in 2025:

• 4,328 were related to pharmacy benefits, 3,287 were related to medical benefits and 150 were related to behavioral health benefits.
• 7,765 were denied because the patient did not meet prior authorization criteria, 0 were denied due to incomplete information submitted by the care provider, 0 were denied due to a change in treatment program and 0 were denied because the patient was no longer covered by a plan.
• 6,890 denials were not appealed, and 875 denials were appealed. 698 denials were upheld on appeal, and 177 denials were reversed on appeal.