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Drug information and resources

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Prior authorization, quantity limits & step therapy

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Prior authorization, quantity limits & step therapy

Some drugs have rules you need to follow before we cover them. These include:

 

  • Prior authorization
    You or your doctor needs approval from us before we cover the drug.
  • Quantity limits
    For certain drugs, we limit the amount you can get.
  • Step therapy
    We require you to try another drug first before we cover your drug.

You and your doctor can ask us to make an exception to one of our coverage rules. This includes requesting an exception to a prior authorization, quantity limit or step therapy rule.

Transition rules

Transition rules

There may be times where you’re taking a drug that either isn’t on our drug list or has special rules before we cover it. Learn about our transition process to see if you’re eligible for a short-term supply of medication. This temporary supply allows you to work with your doctor to either transition to a new drug or request an exception to continue your current drug.
 

Details about our 2020 transition process

Details about our 2021 transition process

 

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