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These prescription drugs require your doctor to get approval before the plan will cover the cost of the medication.
Prior authorization may be required through our Specialty Medical Benefit Management program.
The drugs on this list must be filled under the pharmacy benefit and are not covered under the medical benefit.
This program limits the amount of medication prescribed at one time for certain covered prescriptions.
These prescription drugs, normally tier 4, are usually used to treat complex or chronic medical conditions.
Our pharmacy committee decides exclude some drugs because other safe, effective, less costly alternatives are available.
Step therapy has you try cost-effective "first-choice" medications before trying more expensive "second-choice" drugs.
The drugs on this list are chosen for their clinical value and cost-effectiveness by an independent panel of physicians and pharmacists.