Prior Authorization (PA) Archive 2012
There are three reasons for the use of prior authorization: scope controls, utilization controls and product based controls. This section includes the list of medications requiring Prior Authorization (PA). PA forms can be found in the Pharmacy Forms section. Incomplete forms will result in either a delay or denial. Please ensure all forms are submitted with all the necessary information to efficiently process the request for the member.
Therapeutic Categories:
- Biologics - Hematopoetic, Immunomodulating, Replacement Therapy, Respiratory, Skeletal
- Cardiovascular - Antihypertensives, Antiplatelet, Clonidine Products, Fibric Acid Derivatives, Lovaza, Revatio, Statins
- 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, Testosterone
- Gastro-Intestinal - Amitiza, Anti-emetic, Anti-Ulcer
- Genitourinary System - Benign Prostatic Hyperplasia (BPH), Bladder Control Drugs
- Ocular/Otic - Ocular Allergy, Ophthalmic Anti-Infective/Steroid, Ophthalmic Glaucoma, Otic Anti-Infective
- Respiratory - Asthma & COPD Inhalation Medications, Antihistamines, Leukotriene Modifiers, Nasal Allergy Sprays, Synagis, Xolair
- Skeletal System - Amrix & Fexmid, Bisphosonates, Forteo, Gout, NSAIDs, Skeletal Muscle Relaxants, Soma
- Topical - Antifungal, Elidel/Protopic, Lidoderm Patch, Pediculicides, Topical Antibiotic Medications, Topical Corticosteroids
Last Modified on
Oct 17, 2025
