To obtain prior authorization, call 1.800.624.6961, ext. 7914 or fax 1.888.329.8471 Attn: Pharmacy.
Newly approved, off-label and/or high-cost infusion drugs require prior authorization. Prior authorization forms are located here.
|Traditional Pharmacy||Drugs that require step therapy, exceed quantity limits, have criteria for coverage or are not on the formulary require prior authorization|
All specialty medications, oral and injectable, require prior authorization. These include, but are not limited to, medications for enzyme replacement therapy, growth hormone deficiency, hemophilia, hepatitis C, idiopathic pulmonary fibrosis, multiple sclerosis, oncology, psoriasis, pulmonary arterial hypertension, rheumatoid arthritis, and other relatively rare conditions. Dispensing of these medications may be limited to preferred providers
The Health Plan Pharmacy Services has a preferred specialty pharmacy network and will direct providers to the preferred specialty pharmacy. Access the list of specialty medications and prior authorization forms here, or call 1.800.624.6961, ext. 7914, option 4.
Note: Specialty pharmacy drugs are covered under the member’s drug rider. Members without an Rx rider do not have coverage for specialty medications. Members with Rx coverage with another carrier must seek coverage for specialty drugs with that carrier.
|Office Administered Drugs||
Dispensing of medications may be limited to preferred providers and all require prior authorization. The list below is not comprehensive: