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. 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 Preapproval Drugs section 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 preapproval is needed for the drug. The member's provider will need to contact our Pharmacy Services Center to request review.

    After 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

    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.