Our Pharmacy and Therapeutics Committee reviews drug classes and selects preferred agents. Please refer to the Preferred Drug List (PDL) in the printable PDF format or utilize our searchable PDL feature for the most up-to-date information on preferred agents for specific drug classes. Some drug products we list in the PDL require prior authorization.
Our pharmacy benefit manager, MedImpact Healthcare Systems, handles most of our prior authorizations. Please use a drug- or drug-class-specific MedImpact medication request form if available. For other drug prior authorization requests MedImpact reviews, please use the general MedImpact Medication Request Form (PDF). You can fax the appropriate MedImpact medication request form to 877-501-1059.
Our specialty pharmacy program manager, Caremark, reviews specialty medication prior authorizations. To request specialty medications, please fax the appropriate Caremark enrollment form to 800-323-2445.