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Prior Authorization (PA)

Prior Authorization Archive - 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015

Covered Drugs for Dual Eligible Individuals

Therapeutic Categories:

  • Anti-Infectives - Cephaloporins, Ketoconazole Oral Tablets, Skin and Soft Tissue, Special Formulations
  • Biologics - Botulinum toxins, Hematopoetic, Immunomodulating, Replacement Therapy, Respiratory, Skeletal
  • Cardiovascular - Anticoagulants, Antihypertensives, Antiplatelet, Antihyperlipidemics, Clonidine Products, Hereditary Angioedema, Pulmonary Arterial Hypertension, Revatio
  • Central Nervous System/Behavioral Health - ADHD & Narcolepsy, Alzheimer's, Antidepressants, Anti-Migraine, Anxiolytic/Hypnotic, Atypical Antipsychotics, Fibromyalgia, Multiple Sclerosis, Narcotic Analgesics, Parkinson's, Restless Leg Syndrome, Requip XL/Mirapex ER, Smoking Cessation, Substance Abuse Treatment
  • Diabetes/Endocrine - Diabetic Medications, Erythropoietin Stimulating Agents, Growth Hormone, Makena®, Testosterone
  • Gastro-Intestinal - Amitiza, Anti-emetic, Anti-Ulcer, Bowel Prep
  • Genitourinary System - Benign Prostatic Hyperplasia (BPH), Bladder Control Drugs
  • Hemophilia - Adynovate, Alprolix, Coagadex, Corifact, Eloctate, Idelvion, Obizur, Tretten
  • Hepatic Disorders - Daklinza, Harvoni, Incivek, Olysio, Sovaldi, Technivie, Victrelis, Viekira Pak, Zepatier
  • Metabolic Disorders- Procysbi, Ravicti, Strensiq
  • Ocular/Otic - Ocular Allergy, Opthalmic Anti-Infective/Steroid, Ophthalmic Corticosteroid, Ophthalmic NSAIDs, Ophthalmic Glaucoma, Otic Anti-Infective
  • Oncologic Therapies - Afinitor, Halaven, Ixempra, Kadcyla, Perjeta, Tykerb 
  • Respiratory - Asthma & COPD Inhalation Medications, Antihistamines, Leukotriene Modifiers, Nasal Allergy Sprays, Pulmonary Arterial Hypertension, Pulmonary Fibrosis, Synagis, Tobi/Pulmozyme, Xolair
  • Skeletal System - Amrix & Fexmid, Bisphosonates, Forteo, Gout, NSAIDs, Skeletal Muscle Relaxants, Soma
  • Special Formulations - Millipred®, Veripred 20®
  • Topical - Antifungal, Elidel/Protopic, Lidoderm Patch, Pediculicides, Topical Antibiotic Medications, Topical Corticosteroids
Last Modified on Dec 14, 2022
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Oklahoma Health Care Authority

4345 N Lincoln Blvd

Oklahoma City, OK 73105

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The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law.