Our prescription drug and medical injectable policies promote safe and effective use by helping physicians select the drug product(s) considered most beneficial to their patients. In order to ensure thorough consideration of both quality-of-care and economic issues, some drugs require prior authorization to be covered under a member's prescription drug or medical benefit. We work with a committee of local physicians and pharmacists to identify medications that should require prior authorization and to develop the medical criteria used to determine when coverage for these agents is appropriate.
Prior authorization is required for injectable medications, including self-administered injectable medications except insulin, glucagon, self-administered epinephrine and injectable chemotherapeutic agents when not available in a physician's office. The following is a complete list of medications requiring prior authorization and their committee-approved criteria.