• Drugs Requiring Approval

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

    Drug Reviews

    Search your drug in our Rx Search tool. Some drugs may require more information from your provider before they can be prescribed and covered by the plan.

    Medical Necessity Review

    Preferred B2 drug lists reviews 

    If the drug you have selected has the Non-Preferred symbol and no Prior Authorization symbol, and you are on the Preferred B2 drug list, a Medical Necessity Review is required. Please use the Preferred B2 form to submit a review. Upon approval, the Tier 2 cost share will be charged.

    Drugs that show both a Non-Preferred symbol and a Prior Authorization symbol need to have a Pharmacy Prior Authorization review.

    Prior Authorization NP Button - Non-Preferred

    Prior Authorization PA Button - Prior Authorization

  • Pharmacy Prior Authorization Program

    Some drugs are part of the Premera Pharmacy Prior Authorization 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 Prior Authorization 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 Prior Authorization is needed for your drug. Your doctor will need to contact our Pharmacy Services Center to request a review.

    Once 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

    Pharmacy Prior Authorization Drugs

    Type in the name of the drug for details about prior authorization criteria, and medical policies.

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

    For drug review requirements specific to your plan, log in and use My Rx Choices to find out if your drug requires pharmacy prior authorization.