Page Title for page template
Search for Required Medical Services-Request Authorization Page Tab Content
Prescription Drugs Authorization Page Content
In order to help assure our members have access to safe, effective drug therapy and to protect against inappropriate use and waste, we require prior authorization and step therapy* on selected prescription medications.
Prior Authorization & Step Therapy Requirements
- Commercial 3-Tier Prior Authorization and Step Therapy Medication ListOpens a PDF
- Child Health Plus Prior Authorization and Step Therapy Medication ListOpens a PDF
- Medicaid Managed Care Prior Authorization and Step Therapy Medication ListOpens a PDF
- Specialty Rx Medication List (Self-Administered Drugs)Opens a PDF
- Provider-Administered Medical Specialty Drugs Requiring Preauthorization - Commercial, Exchange and Medicare Managed CareOpen a PDF
- Provider-Administered Medical Specialty Drugs Requiring Preauthorization - Medicaid Managed Care and Child Health PlusOpen a PDF
Request Approval Online with Electronic Prior Auth (ePA)
You and your staff can request a coverage determination electronically, directly from your electronic medical record (EMR) or through CoverMyMeds ePA Portal.
- You can submit requests for PA prospectively
- You can renew Prior Authorizations 60 days prior to expiration
- ePA through CoverMyMeds is free
- Any authorized personnel can use ePA
Request Approval by Fax or Eform
Send Coverage Determination Request via Secure Eform
* Step Therapy - In some cases, we require members to first try certain drugs to treat their medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat the medical condition, we may not cover Drug B unless the patient tries Drug A first. If Drug A does not work for the patient, we will then cover Drug B.