July 5, 2018
The Pharmacy Prior Authorization program is designed to promote appropriate drug selection, length of therapy, and use of specific drugs while improving the overall quality of care.
Premera has added new review criteria based on clinical best practice and approval by an independent pharmacy and therapeutics committee. Drugs may be added or deleted from this list without notification.
If you have questions, read more about the Pharmacy Prior Authorization program or call the Pharmacy Services Center at 888-261-1756 or fax us at 888-260-9836, Monday through Friday, 8 a.m.-5 p.m. Pacific time.
Which new edits are included in the Pharmacy Prior Authorization Edit Program?
Effective: May 17, 2018
Aimovig™ (erenumab)
Read the full policy.
Coverage criteria
Aimovig™ (erenumab) may be considered medically necessary in patients with an average of more than 4 migraine days per month who have:
- Failed at least three preventive migraine therapies
and
- Are receiving a maximum monthly supply of abortive migraine treatments
Initial Approval
Initial approval for three months requires all of the following:
- Failure to achieve control during adequate trials of at least three prophylactic medications (at least two months on each therapy)
and
- Receiving maximum doses of a triptan abortive therapy, unless contraindicated
Reauthorization
Continued therapy will be approved for periods of one year as long as the patient has shown and continues to show a sustained reduction in headache frequency compared to baseline prior to initiation of treatment with erenumab.
Required Documentation
Chart notes describing patient’s diagnosis and progress including headache frequency; medication history, if not documented by our prescription claims record.
Effective: June 8, 2018
Adirca® (tadalafil)
Read the full policy.
Coverage criteria
The following therapies may be considered medically necessary for the treatment of pulmonary arterial hypertension (PAH/ WHO Group 1):
- Adirca® (tadalafil) (oral)