Clinical Prior Authorization (CPA)
Prescription Management Program

Certain prescription medications require a Clinical Prior Authorization (CPA) (approval from the Health Plan) before they will be covered. Types of Clinical Prior Authorizations include, but are not limited to, medications with quantity limitations, age limitations, and/or requiring clinical determinations for appropriate use. The Health Plan’s prescription vendor administers the Clinical Prior Authorization process on behalf of the Health Plan.
 
Impacted Medications
Acne Medications (Oral & Topical) such as Tretinoins (Retin A) & Claravis for ages 25 and older
Anabolic Steroids such as Nandrolone, Oxandrolone & Winstrol
Anti-Abuse Drugs such as Suboxone
Anti-Diabetic Injectables such as Byetta
Benign Prostatic Hyperplasia (BPH) Agents such as Cialis
Boniva
Lidoderm Pain Patches
Reclast/Bandronate
Botulinums such as Botox
Growth Hormones
Narcolepsy Drugs such as Mondafinil (generic for Provigil)
Omega-3-Acid Ethyl Esters such as Lovaza
Opioids (Short-Acting) such as Actiq
Progesterone Support such as Crinone 8%
All Specialty Pharmacy Drugs
 
Disclaimer: The Health Plan reserves the right to add or remove medications from this list at any time. Contact the Health Plan Administration Office to verify whether a covered medication is subject to a Clinical Prior Authorization (CPA).