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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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