To obtain prior authorization, call 1.800.624.6961, ext. 7914 or fax 304.885.7592 Attn: Pharmacy.
Newly approved, off-label and/or high-cost infusion drugs require prior authorization. Prior authorization forms are located here.
|Traditional Pharmacy||Drugs that require step therapy, exceed quantity limits, have criteria for coverage or are not on the formulary require prior authorization|
All specialty medications, oral and injectable, require prior authorization. These include, but are not limited to, medications for enzyme replacement therapy, growth hormone deficiency, hemophilia, hepatitis C, idiopathic pulmonary fibrosis, multiple sclerosis, oncology, psoriasis, pulmonary arterial hypertension, rheumatoid arthritis, and other relatively rare conditions. Dispensing of these medications may be limited to preferred providers
The Health Plan Pharmacy Services has a preferred specialty pharmacy network and will direct providers to the preferred specialty pharmacy. Access a list of specialty pharmacy medications by logging into The Health Plan’s secure provider portal. Note that this list is not comprehensive.
|Office Administered Drugs||
Dispensing of medications may be limited to preferred providers and all require prior authorization. For a complete listing of medically billable drug codes and their authorization requirements, please log into The Health Plan’s secure provider portal.