Pharmacy Policies

Pharmacy Policies

  1. Search the Well Sense Covered Drug List for coverage of specific medications.
  2. If you feel it is medically necessary for a member to take a medication that’s not covered, please submit a prior authorization request through an electronic PA portal for the fastest coverage determination.
  3. Be sure to check all clinical guidelines before submitting your coverage request. All pharmacy policies and criteria are listed in the searchable library below. Please use Google Chrome for the best user experience.

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2021 Drug List

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Community Mental Health Center Providers Only

Prior Authorization requirements for Behavioral Health Medications for CMHC providers in NH:

Other Drug Exceptions

Use the forms below to request a prior authorization for drugs not found in our formulary, newly marketed drugs, brand-name drugs or for quantity limit exceptions.