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Drugs with new or expanded indication

Drug - Drugs with new or expanded indication

October 2022


  • To ensure that drugs, currently require prior authorization but are FDA-approved for new or expanded indication, are not the first drug used when other safe and effective options exist
  • To ensure that the patient is a good candidate to receive benefit from the newly approved drug

Prior authorization criteria for approval of drugs with new or expanded indication

  • Drug is restricted to FDA approved indications AND
  • Other therapies for the disease state have been tried at a reasonable dose and duration without success (intolerance or ineffectiveness), or there is no existing therapy AND 
  • Prescribing physician must make a statement of anticipated benefit and defines when efficacy will be reevaluated


Contact the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 with questions.

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