How we ensure the safe use of prescriptions
We use a number of pharmacy programs to promote the safe and correct use of certain drugs. Drugs that belong to these programs have medical policies that must be met before we cover them. Here's a summary of our pharmacy programs:
Prior Authorization Program
Some drugs require your doctor or nurse to get prior approval, or prior authorization, from us before you can fill a prescription. If a drug falls into this group and may be medically necessary for you, your doctor can submit a request to us to cover your prescription, or you can submit a request yourself.
- Prior authorization drug list for 2021
- Prior authorization drug list for 2022
- Submit a prior authorization request
Step Therapy Program
Step therapy requires that you try certain covered drugs before we will cover another similar drug. If you and your doctor feel that a covered drug is not appropriate to treat your medical condition, your doctor can submit a prior approval request.
Quantity Limitation Program
This program ensures the safe and appropriate use of some drugs. We may put limits on the amount of a drug that can be given by the pharmacist at one time. If your doctor feels that a greater amount is medically necessary for you, they can submit a prior authorization request.
Specialty Pharmacy Program
This program requires some drugs to be supplied by a specialty pharmacy. These drugs include oral, injectable and intravenous drugs that are often used to treat chronic (ongoing) conditions and require the additional expertise and support of a specialty pharmacy. We contract with certain specialty pharmacies to provide these drugs.
Mail Order Drug Program
Get your prescriptions by mail to save time and money. Learn more about our Mail Order Drug Program.
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