Medical Drug Management
Please note:
Adobe PDF Reader is required to view clinical guideline documents.
There may be instances in which your health plan policies take precedence over the EviCore by Evernorth clinical guidelines. If you have any questions, please reach out to your health plan.
If you would like to view all EviCore core guidelines, please type in "EviCore by Evernorth" as your health plan.
Follow the below steps to access the clinical guidelines.
- Enter your Health Plan name into the search field and click on the magnifying glass.
- To access the guideline specific to your request, locate the requested drug found in your letter.
- Identify the guideline title and then search for that guideline title by scrolling down on the page or entering the guideline title into the guideline name search field.
- Open the guideline.
Example:
Your letter states: “……has asked EviCore to approve you for a CPT J0897 - Denosumab injection for the…”
Enter your Health Plan name into the search field and click on the magnifying glass, then scroll down to search for requested drug. You can also enter the drug name into the guideline title search field. Click on the corresponding guideline to open the guideline document (example: Denosumab).
If you require a copy of the guidelines that were used to make a determination on a specific request of treatment or services, please email the case number and request to: reqcriteria@EviCore.com.
To request any additional assistance in accessing the guidelines, provide feedback or clinical evidence related to the evidence-based guidelines, please click here.