Drug Formulary

What is prior authorization and when is it needed?

Prior Authorization is a process that monitors the use of certain drugs to ensure they are prescribed in appropriate clinical situations. Drugs subject to prior authorization typically have safety issues, a high potential for inappropriate use, and/or have lower-priced alternatives on the formulary.

Drugs requiring prior authorization must meet specific criteria for use before they will be considered a covered benefit. The process usually involves these steps:

  1. Your practitioner submits certain medical information to help us make a decision.
  2. Your practitioner’s office and you are notified as to whether or not the drug is approved.
  3. If a drug prior authorization has been denied or not submitted, your pharmacy will not be able to file the drug claim under your prescription benefit, so you will be responsible for the entire cost of the prescription.

To view/print the prior authorization form to initiate a prior authorization, click here.

To view/print the list of drugs requiring prior authorization, click here.