2026 Prior Authorization Grids

Behavioral Health

Applies to: B – UFC/ACC, B – UFC/ALTCS

• Behavioral Health Prior Authorization Grid | Effective 01/01/2026

Medical

Applies to: Banner Medicare Advantage Dual HMO D-SNP, Banner Medicare Advantage Prime HMO

• Medical Prior Authorization Grid | Effective 01/01/2026

Applies to: B – UFC/ACC, B – UFC/ALTCS

• Medical Prior Authorization Grid | Effective 01/01/2026
  

Medical Medication Step Therapy Guide

Applies to: B – UFC/ACC, B – UFC/ALTCS

• Medical Medication Step Therapy Guide | Effective 01/01/2026

Pharmacy

Applies to: B – UFC/ACC, B – UFC/ALTCS

• Pharmacy Prior Authorization Grid | Effective 01/1/2026