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Prior Authorization List

Drugs Requiring Prior Authorization - October 2011
Drugs Requiring Prior Authorization - July 2010
Drugs Requiring Prior Authorization - June 2011


Speciality Drugs Requiring Prior Authorizations - Commercial
All unclassified drug codes (such as J3490, J3590, J8999 and J9999) require prior authorization. When requesting authorization for an unclassified drug please submit the NDC#, Drug Name, and Dosage.

2010 Drug Prior Authorizations – Medicare

Drug Prior Authorizations - Medicare

Procedures Requiring Prior Authorization (Group)

Procedures Requiring Prior Authorization (Medicare)

DME Precertification Form

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