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Prior Authorization and Step Therapy

To ensure that members receive the most appropriate and cost-effective drug therapy, some plans require that additional steps be taken before certain drugs are covered:


  • Prior Authorization: Certain clinical criteria must be met before some drugs are covered. Your doctor should call our pharmacy help desk to request prior authorization for these drugs.
  • Step Therapy: Requires that you have tried an alternative therapy first or that your doctor has clinically documented why you cannot take the alternate therapy. Step therapy may include select covered over-the-counter products.

Which drugs require prior authorization or step therapy?

Each type of formulary has its own list of drugs that require prior authorization or step therapy:

Questions? We can help!

Not sure which formulary you should refer to or which Prior Authorization/Step Therapy list above applies to you? Have other questions about your pharmacy benefits? Contact customer service.


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