Drug Coverage Policies
Below are links to our policies relating to drug coverage, including limitations, criteria for coverage, and treatment guidelines.
Requires Prior Authorization
- Benzodiazepines
- Botulinum toxin
- Buprenorphine and buprenorphine/naloxone transmucosal
- Buprenorphine transdermal
- Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonists for Migraine Prophylaxis
- Compounded drug products
- Direct-acting antivirals for hepatitis C
- Drug Therapy for Acute Treatment of Migraine Headache
- Drug therapy for neuropathic pain
- Hyaluronic acids or viscosupplementation
- Opioids for non-cancer pain
- Phosphodiesterase-5 (PED5) inhibitors quantity limit for erectile dysfunction
- Tobacco cessation for surgical care
- Tramadol