Prior Authorization/Step Therapy Criteria

Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:

  • Prior Authorization: Requires a member to get prior authorization for certain drugs before a prescription is filled. If the member does not get approval, the plan may not cover the drug.
  • Quantity Limits: For certain drugs, the plan limits the amount of the drug that will be covered.
  • Step Therapy: In some cases, the plan requires a member to first try certain drugs to treat a medical condition before another drug will be covered for that condition.  

Get more information on prior authorization, quantity limit or step therapy requirements.