Prior Authorization Is Required for Some Drugs

Prior Authorization Is Required for Some Drugs

Prior authorization programs are most often used to help encourage the proper use of medicines. This can also help to lower the chances of unnecessary drug treatment and help contain overall health care costs.

Prior authorization is a clinical program that only applies to certain types of prescription medicines. Prescription medicines subject to the prior authorization program will need pre-approval before they can qualify for coverage under your pharmacy benefit plan.

Most commonly prescribed medicines under your pharmacy benefit plan do not require prior authorization. However, depending upon your specific benefit plan, a prior authorization program may be in effect for one or more prescription drugs prescribed by your doctor.

These are a few medications* that do require prior authorization:

  • Androgens/Anabolic Steroids: Anadrol-50, Androderm, AndroGel, Aveed, Axiron, danazol, Delatestryl, Depo-Testosterone, Fortesta, Jatenzo, Methitest, Methyltestosterone capsule, Natesto, Oxandrin, oxandrolone, Striant, Testim, Testopel, testosterone cypionate, testosterone enanthate, testosterone gel/solution, Vogelxo, Xyosted
  • Antifungal Agents: Cresemba, Noxafil/posaconazole, Tolsura, Vfend/voriconazole
  • Erectile Dysfunction: Caverject, Edex, Muse, Cialis, Levitra, sildenafil, Staxyn, Stendra, tadalafil, vardenafil, Viagra
  • Growth Hormones: Genotropin, Genotropin Miniquick, Egrifta, Humatrope, Norditropin Flexpro, Norditropin NordiFlex, Nutropin AQ, Nutropin AQ Nuspin, Omnitrope, Saizen, Serostim, Zomacton, Zorbtive
  • Hepatitis C Direct Acting Antivirals: Daklinza, Epclusa, Harvoni, Ledipasvir/Sofosbuvir, Mavyret, Olysio, Sofosbuvir/Velpatasvir, Sovaldi, Technivie, Viekira PAK, Viekira XR, Vosevi, Zepatier
  • Metformin Extended Release: Fortamet, Glumetza, metformin modified release, metformin osmotic ER
  • Narcolepsy: Nuvigil, Provigil
  • Ophthalmic Immunomodulators: Cequa, Restasis, Xiidra
  • Oral Tetracycline Derivatives: Acticlate, Doryx, Doryx MPC, doxycycline, doxycycline monohydrate, Minocin, minocycline tablet, Minocycline SR, Minolira, Monodox, Oracea, Seysara, Solodyn, Targadox, Vibramycin, Ximino

Your pharmacist will turn in the request for prior authorization if it is required.

Not all drug categories are included in all benefit plans. Additional categories may be added and the program may change from time to time.

To learn more or to check your medications’ requirements, visit bcbsok.com or call the customer service number on your member ID card.

*Third-party brand names are the property of their respective owners.

Originally published 5/11/2020; Revised 2021

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