• 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 for a drug in our Rx Search tool. Some drugs may require more information 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 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. Medications for certain conditions – such as migraines, diabetes, high blood pressure or asthma – may need to meet certain requirements before a prescription is covered.

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

    How the program works

    When a prescription is filled at the pharmacy, the prescription is checked to see if it meets recommended guidelines:

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

    Review process

    The member or the pharmacy can call the member's provider with notification that a pharmacy Prior Authorization is needed for the drug. The member's provider will need to contact our Pharmacy Services Center to request review.

    Once we receive the provider's information, our review process takes one to two business days. We’ll then send the member a letter confirming the decision made about the member's prescription coverage. We’ll also fax the decision to the member's provider.

    • If the prescription is approved, it will be covered by the member’s prescription benefits, and can be filled at the pharmacy.
    • If the prescription is not approved, it will not be covered by the member’s prescription benefits; the member should talk to his/her provider about an alternate medicine

    Pharmacy Prior Authorization Drugs

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

    If the drug name is not found, type OTHER to access a blank fax back form to complete and submit for review.

    Prior Authorization Note 

     

     

    Universal Pharmacy Prior Authorization Form 

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