Prescriptions that Require Pre-Authorization for Commercial Members for 2008
Certain Prescription Drugs require prior coverage authorization. For instructions on how to obtain prior authorization, please contact Member Services at 383-3311 Monday through Friday, 8 a.m. to 5 p.m.
All injectables* (except insulin, EpiPen, EpiPen Jr., Glucagon, Heparin, Imitrex, Lovenox, Methotrexate, Twinject)
ANTI-SEIZURE TREATMENT
Gabitril
Keppra
Lamictal
Lyrica
Topamax
Trileptal
MISCELLANEOUS
Buprenex
Byetta
Increlex
Iressa
Orencia
Provigil
Qualaquin
Regranex
Revatio
Revlimid
Suboxone
Subutex
Symlin
Tracleer
Ventavis
Xolair
Xyrem