Prior authorization programs are most often used to help encourage the proper use of medicines. This can also help to lower the chances of unnecessary drug treatment and help contain overall health care costs.
Prior authorization is a clinical program that only applies to certain types of prescription medicines. Prescription medicines subject to the prior authorization program will need pre-approval before they can qualify for coverage under your pharmacy benefit plan.
Most commonly prescribed medicines under your pharmacy benefit plan do not require prior authorization. However, depending upon your specific benefit plan, a prior authorization program may be in effect for one or more prescription drugs prescribed by your doctor.
Below are a few medications* that do require prior authorization:
- Anabolic steroids: Anadrol, Anadrol, Androderm, Androgel, Android, Androxy, Aveed, Axiron, Danazol, Delatestryl, Depo-Testosterone, First-Testoster, Fortesta, Methitest, Natesto, Oxandrin, Striant, Testim, Testone CIK, Testopel, Testred, Vogelxo
- Antifungal agents: Cresemba, Noxafil, Vfend/voriconazole
- Erectile dysfunction medicines: Caverject, Cialis, Edex, Levitra, Muse, Staxyn, Stendra, Viagra
- Growth hormones: Genotropin, Humatrope, Norditropin, Nutropin AQ, Omnitrope, Saizen, Serostim, Tev-Tropin, Zomacton, Zorbtive
- Hepatitis C medicines: Daklina, Epclusa, Harvoni, Mavyret, Olysio, Sovaldi, Technivie, Viekira PAK, Viekira XR, Zepatier
- Narcolepsy medicines: Nuvigil/armodafanil, Provigil/modafanil
- Transmucosal immediate release fentanyl: Abstral, Actiq/fentanyl, Fentora, Lazandam, Subsys
Additional categories may be added and the program may change from time to time.
To learn more or to check your medications’ requirements, visit bcbsok.com or call the customer service number on your member ID card.
*Third-party brand names are the property of their respective owners.