As part of our coverage criteria and drug list (formulary) policies, some services and medicines require prior authorization before our health plans cover them. Every year, we post details about the prior authorization requests we received the previous year and how we responded to them.
Total prior authorization requests

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.
 Denied prior authorization requests

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.
Learn more about prior authorizations

For more information about prior authorizations (including how to request one), you can:

You can also access many request forms for pharmacy prior authorizations or exceptions on our member forms page or by signing in to your online account.