Prescription Coverage - Prior Authorizations

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» About Clinical Prior Authorizations
» Clinical Prior Authorization Covered Medications

Other Prescription Management Controls:
» Prior Authorizations: Click Here
» Exclusions: Click Here
» Quantity & Age Limitations: Click Here
» Specialty Medications: Click Here
» Step Therapies: Click Here
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About Clinical Prior Authorizations

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, prescriptions with quantity limitations, age limitations, and/or require clinical determinations for appropriate use. The Health Plan’s Prescription Drug program vendor administers the Clinical Prior Authorization process on behalf of the Health Plan. A listing of prescription medications requiring a Clinical Prior Authorization is shown below:
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Disclaimer: The Health Plan reserves the right to add or remove medications from this list at any time, so please contact the Health Plan Administration office to verify whether a covered medication is subject to a Clinical Prior Authorization (CPA).
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Clinical Prior Authorization Covered 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, so please contact the Health Plan Administration office to verify whether a covered medication is subject to a Clinical Prior Authorization (CPA).
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