Prior Authorization
SummaCare utilizes one prior authorization list for all fully-insured PPO/POS/HMO and Medicare (Secure) plans.
To view prior authorization lists for self-funded groups, please visit Plan Central and click on "Related Documents" after logging in.
Prior Authorization List
Prior Authorization Fax Form
Elements of Informed Consent for Genetic Testing (For Provider Use Only, Do Not Fax)
Prior Authorization for Genetic Testing Fax Form
After-Hours Authorizations
Prior Authorization Criteria for Provider-Administered Injectable and Infusions:
The following list of injectables and infusions require prior authorization and are covered under the major medical benefit because they are typically administered in an office or outpatient setting.
Select the drug name to view SummaCare’s criteria for these drugs.
Please call 330-996-8805 to initiate the prior authorization process or to ask questions. Coverage decisions are based on plan benefits and appropriateness of care.
Note: Offices that buy and bill do not need to obtain authorization for Sandostatin LAR® and Thyrogen®.