Approved Drug List
Some drugs may require your provider to fill out an authorization form.
- Commercial/Individual prior authorization criteria
- Pharmacy drug request
- Oral oncology drug request
- Opioid quantity limit exception request
Drugs covered under the medical benefit
- Medical Benefit Drug List (MBDL) (formerly the Injectable Drug List)
- Medical drug request
- Oncology medical drug request
Check your plan documents to see whether one of the below riders is included in your plan.
IRS-allowed Chronic Condition Services, Supplies and Prescription Drug rider
Medical drug-specific forms are linked in the Medical Benefit Drug List.