Drugs Requiring Approval

  • On drugs required for certain medical conditions, preapproval may be needed before the prescription is covered. Learn more about situations where preapproval is required.

  • Some drugs are part of the Premera Pharmacy Preapproval Program. If you take medications for certain conditions—such as migraines, diabetes, high blood pressure or asthma—you may need to meet certain requirements before your prescription is covered.

    Go to the Pharmacy Preapproval Drugs tab to see if your drug requires this type of pre-service review.

    How the program works

    When you go to the pharmacy to fill your prescription, your prescription drug therapy is checked to see if it meets recommended guidelines:

    • If the drug meets these guidelines, your prescription is filled without interruption.
    • If the drug does not meet the guidelines, your prescription will not be filled until it has been reviewed.

    Review process

    You or your pharmacy can call your doctor to notify him or her that a Pharmacy Preapproval is needed for your drug. Your doctor will need to contact our Pharmacy Services Center to request a review.

    After we receive your doctor’s information, our review process will take one to two business days. Then we’ll send you a letter confirming the decision made about your prescription coverage. We’ll also fax the decision to your doctor.

    • If your prescription is approved, then it will be covered by your prescription benefits, and can be filled at your pharmacy.
    • If your prescription is not approved, then it will not be covered by your prescription benefits and you should talk to your doctor about an alternate medicine.

    Type the name of the drug to get details about preapproval criteria and medical policies.

    Note: This list shows drugs that require pharmacy preapproval that are common to all plans.

    To find out if your medicine requires pharmacy preapproval, sign in and access Express Scripts via your Pharmacy Services page.

    Universal Pharmacy Preapproval Form

    *This form can be used to submit all types of requests for medical necessity.