Medications for certain conditions-such as migraines, diabetes, or high blood pressure-may need to meet certain requirements before a prescription is covered. See the Pre-approval Drugs section to see if the drug requires a pre-approval, quantity limit, or step therapy review.
Type in the name of the drug to view pre-approval criteria, the drug's corresponding medical policy, and a link to an online fax form. As another option, you can use the Pharmacy Pre-approval Request fax form to submit all types of pharmacy authorization requests.
Note: The Rx search tool shows drugs that require pharmacy pre-approval common to all plans. For drug review requirements specific to a customer's plan, log in to My Rx Choices via MyPharmacyPlus™ to view drug review requirements specific to their plan.
For School Employees Benefits Board (SEBB) members only: Premera is committed to safe pain management. As of May 1, 2020, an opioid attestation form is required when patients begin chronic opioid use and/or daily doses exceed 120 morphine milligram equivalents. Patients undergoing active cancer treatment, hospice, palliative care, end-of-life, or medically necessary care might be exempt from quantity limits. Expedited authorization codes can be provided in these cases. For more information or expedited authorization codes, call Premera Blue Cross pharmacy services at 888-261-1756.
View opioid attestation form