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Some drugs require prior approval before they are covered. This is so the plan can best guide the correct use of these drugs. Your doctor can help you get approval. To learn more about prior authorization, select the link below.
Prior Authorization Criteria and Form
You may be asked to start treatment with a drug that costs less but works just as well (for example, a generic name drug) instead of starting with a drug that costs more. If the first drug doesn’t work for you, then the plan will cover the higher-priced drug. For more information about step therapy, select the link below.
Step Therapy Criteria and Form
There can be a limit on how much of a drug you’re allowed, which can include how many pills you get with each prescription. These limits are based on safety guidelines. To learn more about quantity limits, select the link below.
Quantity Limits Exception Form
Drug utilization reviews help make sure you're getting safe and proper care. They are very important if you have more than one doctor prescribing your medications. The review is done each time you fill a prescription, as well as on a regular basis. We look for issues such as:
If we find a problem during the review, we’ll work with your doctor to fix it.
Last Updated: Sept. 05, 2022
Last Updated: 09302022