Medical Preauthorization

Certain drugs require review and preauthorization before medical benefits are approved for a member. The steps you follow to submit a prescription preauthorization will depend on the type of drug. Choose an option below to look up a drug and submit a preauthorization.

Chemotherapy Drugs

Most chemotherapy drugs require preauthorization.

See Chemo Drug List

Medical Benefit Drugs

See Medical Benefit List

Avera Health Plans Preauthorization

See Avera Health Plans List

Avera Care System (UMR) Preauthorization

See ACS (UMR) List

Products and Services Considered Experimental and Investigational

See Experimental and Investigational List

Medical Preauthorization and Notification Requirements

If preauthorization is needed, submit the appropriate form and clinical documentation.

  • For non-Avera providers, submit the preauthorization request and clinical documentation to Avera Health Plans via the Avera System Link portal.
  • For Avera providers, submit the preauthorization request and clinical documentation to Avera Health Plans via EPIC.

Preauthorization Forms

Procedure-Specific

For these products or services requiring preauthorization, we recommend completing and submitting the applicable preauthorization form(s), otherwise submission of medical records will be required.

If you are not an Avera provider and are currently in the process of getting a System Link account, you can use this form and fax it to 866-394-1464, or send a secure email to HealthServices@AveraHealthPlans.com.

If you are an Avera provider or have access to System Link, this form will not be processed and you will need to resubmit your request.

Have an urgent medical preauthorization request? Call 888-605-1331 to submit an urgent request, and we will respond in 24 hours. Use this approach if a delay in approval could jeopardize the patient’s life, health or ability to regain maximum function, or would cause severe pain that could not be adequately managed without the requested care or treatment. 

Prescriptions and Pharmacy Preauthorizations

Certain drugs require review and preauthorization before pharmacy benefits are approved for a member. The steps you follow to submit a prescription preauthorization will depend on the type of drug. Choose an option below to look up a drug and submit a preauthorization.

Questions? Providers should contact our pharmacy team at 833-464-7663.

Chemotherapy Drugs

Most chemotherapy drugs require preauthorization.

See Chemo List

Pharmacy Benefit Drugs

See Pharmacy List

Step Therapy

Some step therapy drugs require preauthorization.

See Step Therapy List