Medications

The following medications or classes of medications require prior authorization. Medications may appear more than once. Please verify you are selecting the medication in the correct category to ensure you download the correct form. Please be aware that as new products are released and post-marketing information on existing therapies becomes available, changes in this list may occur. Physicians and pharmacy providers will be notified of any such changes via newsletters and direct mailings.

Medications Not Found
All new-to-market medications will require a Prior Authorization. If the medication you are looking for is a new-to-market drug, or is not listed, please complete the General Prior Authorization form.

Name Brand Medications with an available generic
Brand name drugs with an available generic requires the use of that generic. If there is a clinical reason the patient cannot use the generic, it is requires a Prior Authorization.

Medications requiring Prior Authorization

* These drugs require alternate site of care infusion other than outpatient hospital

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Medications requiring Step Therapy

BCBSKC will provide coverage for a Brand medication, only if the generic equivalent has been tried and failed; unless other step therapy or prior authorization requirements apply. Some medications may require two preferred alternatives before the name brand will be covered.

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Medications with Quantity Limits

Quantity limit refers to the amount of a drug needed to take the daily dose, according to the recommendations of the U.S. Food and Drug Administration (FDA). Quantity limits promote safe, cost-effective drug use and reduce waste and overuse. These limits are designed to control the use of selected drugs for quality and safety reasons. Prior authorization is required to go beyond the quantity limit.

The following list is subject to change and does not guarantee coverage. Use the search box at the top of this PDF to locate a specific drug.

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Medications that must be obtained from an approved Specialty Provider (pharmacy or infusion) Often, limited to 30 day supply

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Federal Employee Advance Medical Review

The following medications or classes of medications require advance review. Please verify you are selecting the medication in the correct category to ensure you download the correct form. Please be aware that as new products are released and post-marketing information on existing therapies becomes available, changes in this list may occur. Physicians and pharmacy providers will be notified of any such changes via newsletters and direct mailings.

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Is the drug you are requesting an oral, topical, or self-injectable medication?

If yes, please do not complete this form. Call Caremark PCS at 800-624-5060.

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