Prior Authorization & Quantity Level
Limits
Prior authorization requirements and quantity level
limits have been established for select medications
in order to promote their appropriate use, while deterring
unproven or experimental usages.
- Some medications may have quantity limits
- Some medications may require prior authorization
View the prior
authorization list.
Submitting a Prior Authorization Request
Prior
Authorization Request Forms (PDF) may be faxed
or submitted online.
- Forms must be complete, neat and accurate
- Certain medications require that corresponding
chart notes be faxed with the form
Medications Requiring Prior Authorization
- Non-formulary medications must be approved for
members on closed formulary plans
- Formulary alternatives must be tried and
failed first
- Medications requiring prior authorization include
those that have:
- Set quantity limits
- Less expensive options
- May be prone to overuse
- Present potential safety issues
- Limited uses based on scientific studies
or FDA approval
- May be prescribed for conditions which are
not covered or that require diagnostic tests
to ensure medical benefit
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