Drug - Prior Authorization List of Drugs

Please be advised, commencing treatment without prior authorization does not guarantee continued coverage.

Below are the drugs that require prior authorization. To find the applicable form for any of the conditions or drugs listed below, please log on to Benefits Now^® Plan Member.

Drug - Prior Authorization List of Drugs

Enter text to search  

• A

• Abiraterone
• Abraxane / Cancer
• Abrilada / Ankylosing Spondylitis
• Abrilada / Crohn's Disease/ Ulcerative Colitis
• Abrilada / Hidradenitis Suppurativa
• Abrilada / Juvenile Idiopathic Arthritis
• Abrilada / Psoriatic Arthritis
• Abrilada / Rheumatoid Arthritis
• Abrilada  / Severe Psoriasis
• Abrilada / Uveitis
• Actemra / Rheumatoid Arthritis
• Adcetris
• Adcirca / All Other
• Adempas / All Other
• Adtralza
• Afatinib
• Afinitor / Cancer
• Agrylin / Cancer
• Aimovig
• Ajovy
• Akeega
• Aldurazyme / All Other
• Alecensaro / Cancer
• Alimta / Cancer
• Alunbrig / All Other
• Ambrisentan / All Other
• Amgevita / Ankylosing Spondylitis
• Amgevita / Crohn's Disease/ Ulcerative Colitis
• Amgevita / Hidradenitis Suppurativa
• Amgevita / Psoriatic Arthritis
• Amgevita / Rheumatoid Arthritis
• Amgevita / Severe Psoriasis
• Amgevita / Uveitis
• Amvuttra
• Apremilast
• Apretude
• Aptiom / All Other
• Aptivus / All Other
• Aranesp / All Other
• Arixtra / All Other
• Arsenic Trioxide / Cancer
• Atgam / All Other
• Atriance / Cancer
• Aubagio / Multiple Sclerosis
• Avastin / Cancer
• Avonex / Multiple Sclerosis
• Avsola / Ankylosing Spondylitis
• Avsola / Crohn's Disease/ Ulcerative Colitis
• Avsola / Psoriatic arthritis
• Avsola / Rheumatoid Arthritis
• Avsola / Severe psoriasis
• Aybintio
• Azacitidine / Severe psoriasis

• B

• Bambevi
• Banzel / All Other
• Bavencio
• Benlysta / All Other
• Benvyon
• Beovu
• Besponsa / Cancer
• Betaseron / Multiple Sclerosis
• Bimzelx
• Bortezomib
• Bosentan / All Other
• Bosulif / Cancer
• Botox / Chronic Migraine
• Botox / Specialty Drug
• Braftovi
• Brenzys / Ankylosing Spondylitis
• Brenzys / Juvenile Idopathic Arthritis
• Brenzys / Psoriatic Arthritis
• Brenzys / Rheumatoid Arthritis
• Brenzys / Severe Psoriasis
• Brineura
• Butorphanol / All Other
• Bydureon
• Byooviz

• C

• Cabazitaxel / Cancer
• Cabenuva
• Cablivi
• Cabometyx / Cancer
• Caelyx / Cancer
• Calquence / All Other
• Camzyos
• Caprelsa / Cancer
• Carbaglu / All Other
• Caripul / All Other
• Cayston / All Other
• Celsentri / All Other
• Cerdelga
• Cerezyme / All Other
• Cibinqo
• Cimzia / Ankylosing Spondylitis
• Cimzia / Non-radiographic Axial Spondyloarthritis
• Cimzia / Psoriatic Arthritis
• Cimzia / Rheumatoid Arthritis
• Cimzia / Severe Psoriasis
• Cinacalcet
• Cinqair / Severe Asthma
• Clolar / Cancer
• Columvi
• Contrave - plans with Anti-Obesity coverage
• Copaxone / Multiple Sclerosis
• Cosentyx / Ankylosing Spondylitis
• Cosentyx / Psoriatic Arthritis
• Cosentyx / Severe Psoriasis
• Cotellic / Cancer
• Cresemba
• Crysvita
• Cuprimine
• Cuvposa
• Cyramza / Cancer
• Cystadane / All Other
• Cystadrops / All Other

• D

• Darzalex
• Dasatinib / Cancer
• Daurismo
• Daxas / All Other
• Deferasirox / All Other
• Dexcom
• Diacomit / All Other
• Dificid / All Other
• Dimethyl Fumarate
• Doxorubicin
• Duodopa / All Other
• Dupixent / Severe Asthma
• Dupixent / All Other
• Dysport

• E

• Ebglyss
• Egrifta / All Other
• Elaprase / All Other
• Elelyso / All Other
• Elrexfio inj sol
• Emgality / All Other
• Empaveli
• Enbrel / Ankylosing Spondylitis
• Enbrel / Juvenile Idiopathic Arthritis
• Enbrel / Psoriatic Arthritis
• Enbrel / Rheumatoid Arthritis
• Enbrel / Severe Psoriasis
• Enhertu
• Enspryng
• Entyvio / Crohn's Disease
• Envarsus / All Other
• Epclusa / Hepatitis C
• Epidiolex
• Eprex / All Other
• Erbitux / Cancer
• Erelzi / Ankylosing Spondylitis
• Erelzi / Juvenile Idiopathic Arthritis
• Erelzi / Psoriatic Arthritis
• Erelzi / Rheumatoid Arthritis
• Erelzi / Severe Psoriasis
• Erivedge / Cancer
• Erleada
• Erlotinib / Cancer
• Esbriet / All Other
• Evenity / Osteoporosis
• Everolimus / Cancer
• Evkeeza
• Evrysdi
• Evusheld
• Exjade / All Other
• Extavia / Multiple Sclerosis
• Eylea / All Other

• F

• Fabrazyme / All Other
• Fampridine
• Fampyra / Multiple Sclerosis
• Fasenra
• Faslodex / Cancer
• Fasturtec / All Other
• Febuxostat / All Other
• Ferriprox / All Other
• Fingolimod / All Other
• Finlius
• Firazyr / All Other
• Firdapse / All Other
• Flolan / All Other
• Fludara / Cancer
• Folotyn / Cancer
• Forteo / Osteoporosis
• Fosrenol / All Other
• Freestyle Libre
• Fulphila / Cancer
• Fuzeon / All Other
• Fycompa / All Other

• G

• Galafold / All Other
• Gazyva / Cancer
• Gefitinib / Cancer
• Gilenya / Multiple Sclerosis
• Giotrif / Cancer
• Givlaari
• Glatect / Multiple Sclerosis
• Glatiramer acetate / Multiple Sclerosis
• Gleevec / Cancer
• Grastofil
• Guardian Sensors

• H

• Hadlima / Ankylosing Spondylitis
• Hadlima / Crohn's Disease/ Ulcerative Colitis
• Hadlima / Hidradenitis Suppurativa
• Hadlima / Psoriatic Arthritis
• Hadlima / Rheumatoid Arthritis
• Hadlima / Severe Psoriasis
• Hadlima / Uveitis
• Halaven / Cancer
• Harvoni / Hepatitis C
• Hemangiol
• Hepsera / All Other
• Herceptin / Cancer
• Hizentra / All Other
• Hulio / Ankylosing Spondylitis
• Hulio / Crohn's Disease/ Ulcerative Colitis
• Hulio / Hidradenitis Suppurativa
• Hulio / Psoriatic Arthritis
• Hulio / Rheumatoid Arthritis
• Hulio / Severe Psoriasis
• Hulio / Uveitis
• Humira / Ankylosing Spondylitis
• Humira / Crohn's Disease / Ulcerative Colitis
• Humira / Hidradenitis Suppurativa
• Humira / Juvenile Idiopathic Arthritis
• Humira / Psoriatic Arthritis
• Humira / Rheumatoid Arthritis
• Humira / Severe Psoriasis
• Humira / Uveitis
• Hyrimoz / Ankylosing Spondylitis
• Hyrimoz / Crohn's Disease/ Ulcerative Colitis
• Hyrimoz / Hidradenitis Suppurativa
• Hyrimoz / Psoriatic Arthritis
• Hyrimoz / Rheumatoid Arthritis
• Hyrimoz / Severe Psoriasis
• Hyrimoz / Uveitis

• I

• Ibavyr / All Other
• Ibrance / Cancer
• Icatibant
• Iclusig / Cancer
• Idacio / Ankylosing Spondylitis
• Idacio / Crohn's Disease / Ulcerative Colitis
• Idacio / Hidradenitis Suppurativa
• Idacio / Psoriatic Arthritis
• Idacio / Rheumatoid Arthritis
• Idacio / Severe Psoriasis
• Idacio / Uveitis
• Idhifa / Cancer
• Ilaris / All Other
• Ilumya
• Imatinib / Cancer
• Imbruvica / Cancer
• Imcivree
• Imdelltra
• Imfinzi
• Inflectra / Ankylosing Spondylitis
• Inflectra / Crohn's Disease / Ulcerative Colitis
• Inflectra / Psoriatic Arthritis
• Inflectra / Rheumatoid Arthritis
• Inflectra / Severe Psoriasis
• Inlyta / Cancer
• Inqovi / Cancer
• Intron A / Cancer
• Intron A / Hepatitis C
• Iressa / Cancer
• Irinotecan / Cancer
• Istodax / Cancer
• Ixifi / Ankylosing Spondylitis
• Ixifi / Crohn's Disease / Ulcerative Colitis
• Ixifi / Psoriatic Arthritis
• Ixifi / Rheumatoid Arthritis
• Ixifi / Severe Psoriasis

• J

• Jadenu / All Other
• Jakavi / Cancer
• Jamteki
• Jemperli
• Jevtana / Cancer
• Jinarc / All Other
• Jorveza
• Juxtapid / High Cholesterol

• K

• Kadcyla / Cancer
• Kalydeco / All Other
• Kanjinti / Cancer
• Kesimpta
• Kevzara
• Keytruda / Cancer
• Kineret / Rheumatoid Arthritis
• Kisqali / Cancer
• Kuvan / All Other
• Kynmobi
• Kyprolis / Cancer

• L

• Lapelga
• Lartruvo / Cancer
• Ledaga
• Lemtrada / Multiple Sclerosis
• Lenalidomide / Cancer
• Lenvima / Cancer
• Leqvio
• Libtayo / Cancer
• Livtencity
• Lokelma / All Other
• Lonsurf / Cancer
• Lorbrena / Cancer
• Lucentis / All Other
• Lynparza / Cancer
• Lysodren / Cancer

• M

• Mabcampath / Cancer
• Matulane / Cancer
• Mavenclad
• Maviret
• Mayzent
• Mekinist / Cancer
• Mektovi / Cancer
• Metoject / All Other
• Miglustat / All Other
• Mounjaro
• Movapo / All Other
• Mozobil / All Other
• Mvasi / Cancer
• Myfembree
• Mylotarg / Cancer
• Myozyme / All Other

• N

• Naglazyme / All Other
• Nerlynx / Cancer
• Neulasta
• Neupogen
• Neupro / All Other
• Nexavar / Cancer
• Nexviazyme
• Nilotinib
• Nimotop
• Ninlaro / Cancer
• Nitisinone / All Other
• Nivestym
• Nplate / All Other
• Nubeqa
• Nucala / Severe Asthma
• Nucala / All Other
• Nypozi
• Nyvepria

• O

• Ocaliva
• Ocrevus
• Octostim / All Other
• Octreotide / Cancer
• Octreotide / All Other
• Odomzo
• Odomzo / Cancer
• Ofev / All Other
• Ogivri / Cancer
• Olumiant / Rheumatoid Arthritis
• Omlyclo / All Other
• Omlyclo / Chronic Idiopathic Urticaria
• Omlyclo / Severe Asthma
• Omvoh
• Onivyde
• Onpattro
• Onstryv / All Other
• Ontruzant
• Opdivo / Cancer
• Opsumit / All Other
• Opsynvi
• Opzelura
• Orencia / Juvenile Idiopathic Arthritis
• Orencia / Psoriatic Arthritis
• Orencia / Rheumatoid Arthritis
• Orfadin / All Other
• Orkambi / All Other
• Orladeyo
• Osnuvo
• Otezla / Psoriatic Arthritis
• Otezla / Severe Psoriasis
• Oxervate / All Other
• Ozempic
• Ozurdex / All Other

• P

• Padcev
• Palbociclib
• Pazopanib
• Pemazyre
• Pemetrexed
• Perjeta / Cancer
• Pheburane / All Other
• Piqray
• Pirfenidone
• Plegridy / Multiple Sclerosis
• Plerixafor
• Polivy / Cancer
• Pomalidomide
• Pomalyst / Cancer
• Ponvory
• Posanol / All Other
• Praluent / High Cholesterol
• Prevymis / All Other
• Procysbi
• Prolastin / All Other
• Pulmozyme / All Other

• Q

• Qinlock
• Quinsair
• Qulipta

• R

• Radicava
• Ranopto
• Ravicti
• Rebif / Multiple Sclerosis
• Reblozyl
• Remicade / Ankylosing Spondylitis
• Remicade / Crohn's Disease / Ulcerative Colitis
• Remicade / Psoriatic Arthritis
• Remicade / Rheumatoid Arthritis
• Remicade / Severe Psoriasis
• Remodulin / All Other
• Remsima / Crohn's Disease/ Ulcerative Colitis
• Remsima / Rheumatoid Arthritis
• Renagel / All Other
• Renflexis / Ankylosing Spondylitis
• Renflexis / Crohn's Disease / Ulcerative Colitis
• Renflexis / Psoriatic Arthritis
• Renflexis / Rheumatoid Arthritis
• Renflexis / Severe Psoriasis
• Renvela / All Other
• Repatha / High Cholesterol
• Replagal / All Other
• Resonium Calcium Powder / All Other
• Retevmo
• Retisert 
• Revatio / All Other
• Revestive / All Other
• Revlimid / Cancer
• Revolade / All Other
• Rezurock
• Riabni / All Other
• Riabni / Cancer
• Riabni / Rheumatoid Arthritis
• Rilutek / All Other
• Riluzole / All Other
• Rinvoq / All Other
• Rinvoq / Psoriatic Arthritis
• Rinvoq / Rheumatoid Arthritis
• Rituxan / Cancer
• Rituxan / Rheumatoid Arthritis
• Riximyo / Cancer
• Riximyo / Rheumatoid Arthritis
• Rozlytrek
• Rukobia ER
• Ruxience / Cancer
• Ruxience / Rheumatoid Arthritis
• Ruzurgi
• Rybelsus
• Rydapt / Cancer
• Rymti

• S

• Samsca / All Other
• Sandostatin LAR / Cancer
• Sandostatin LAR / All Other
• Saphnelo
• Saphris / All Other
• Sativex / All Other
• Saxenda - plans with Anti-Obesity coverage
• Scemblix
• Sensipar / All Other
• Signifor / All Other
• Signifor Lar / All Other
• Siliq
• Simulect / All Other
• Simlandi / Ankylosing Spondylitis
• Simlandi / Crohn's Disease/ Ulcerative Colitis
• Simlandi / Hidradenitis Suppurativa
• Simlandi / Juvenile Idiopathic Arthritis
• Simlandi / Psoriatic Arthritis
• Simlandi / Rheumatoid Arthritis
• Simlandi / Severe Psoriasis
• Skyrizi / Severe Psoriasis
• Soliris / All Other
• Somatuline / All Other
• Simponi / Ankylosing Spondylitis
• Simponi / Crohn's Disease / Ulcerative Colitis
• Simponi / Non-radiographic Axial Spondyloarthritis
• Simponi / Psoriatic Arthritis
• Simponi / Rheumatoid Arthritis
• Sotyktu
• Sovaldi / Hepatitis C
• Spravato
• Sprycel / Cancer
• Stelara / Crohn's Disease / Ulcerative Colitis
  Stelara / Psoriatic Arthritis
• Stelara / Severe Psoriasis
• Steqeyma
• Stivarga / Cancer
• Strensiq / All Other
• Sublocade / All Other
• Sunitinib
• Sunlenca
• Sutent / Cancer
• Sylvant / Cancer
• Symdeko

• T

• Tabrecta
• Tadalafil PAH
• Tafinlar / Cancer
• Tagrisso / Cancer
• Takhzyro
• Taltz / Ankylosing Spondylitis
• Taltz / Psoriatic Arthritis
• Taltz / Severe Psoriasis
• Talvey 
• Talzenna
• Tarceva / Cancer
• Tasigna / Cancer
• Tavneos
• Tecentriq / Cancer
• Tecfidera / Multiple Sclerosis
• Tegsedi
• Temodal / Cancer
• Temozolomide / Cancer
• Tepadina
• Tepmetko
• Teriflunomide
• Teriparatide
• Tezspire
• Thalomid / Cancer
• Thiotepa
• Thyrogen / All Other
• Tobi / All Other
• Tobi Podhaler / All Other
• Tobramycin / All Other
• Tofacitinib
• Tomudex / Cancer
• Torisel / Cancer
• Tracleer / All Other
• Trazimera / Cancer
• Treanda / Cancer
• Tremfya / Psoriatic Arthritis
• Tremfya / Severe Psoriasis
• Tretinoin
• Trientine
• Trikafta
• Trisenox / Cancer
• Trulicity
• Truqap
• Truxima / Cancer
• Truxima Rheumatoid / Arthritis
• Tukysa
• Tykerb / Cancer
• Tysabri / Multiple Sclerosis

• U

• Ubrelvy
• Uloric / All Other
• Ultomiris
• Uptravi / Osteoporosis

• V

• Vabysmo
• Vascepa / Hypercholesterolemia
• Vectibix / Cancer
• Vegzelma
• Veklury 
• Velcade / Cancer
• Velphoro / All Other
• Velsipity
• Veltassa / All Other
• Vemlidy / All Other
• Venclexta / Cancer
• Vesanoid / Cancer
• Verzenio / Cancer
• Victoza
• Vidaza / Cancer
• Vimizim / All Other
• Vizimpro / Cancer
• Visudyne / All Other
• Vitrakvi / Cancer
• Vizimpro
• Vocabria
• Volibris / All Other
• Voriconazole
• Vosevi / Hep C
• Votrient / Cancer
• Voydeya / All Other
• Vpriv / All Other
• Vyalev
• Vyepti
• Vyndaqel / All Other
• Vyvgart 

• W

• Wakix
• Welireg
• Wezlana
• Wyost

• X

• Xalkori / Cancer
• Xeljanz / Crohn's Disease/Ulcerative Colitis
• Xeljanz / Psoriatic Arthritis
• Xeljanz / Rheumatoid Arthritis
• Xeloda / Cancer
• Xenical-Plans with Anti-Obesity coverage / All Other
• Xeomin / All Other
• Xermelo / All Other
• Xgeva / Cancer
• Xiidra
• Xolair / Chronic Idiopathic Urticaria
• Xolair / Severe Asthma
• Xospata
• Xpovio
• Xtandi / Cancer
• Xyrem / All Other

• Y

• Yervoy / All Other
• Yondelis / Cancer
• Yuflyma / Ankylosing Spondylitis
• Yuflyma / Crohn's Disease/ Ulcerative Colitis
• Yuflyma / Hidradenitis Suppurativa
• Yuflyma / Juvenile Idiopathic Arthritis
• Yuflyma / Psoriatic Arthritis
• Yuflyma / Rheumatoid Arthritis
• Yuflyma / Severe Psoriasis
• Yuflyma / Uveitis

• Z

• Zavesca / All Other
• Zelboraf / Cancer
• Zejula / Cancer
• Zepatier / Hepatitis C
• Zeposia
• Ziextenzo
• Zinbryta
• Zirabev / Cancer
• Zoledronic Acid / Cancer
• Zoledronic Acid / Osteoporosis
• Zolgensma
• Zolinza / Cancer
• Zydelig / Cancer
• Zykadia / Cancer
• Zytiga / Cancer
• Zyvoxam / All Other