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 use 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.
General medication request forms
Please submit medication requests on one of the following forms:
Drug-specific medication request forms
Please submit drug-specific pharmacy prior authorization requests to our pharmacy benefit manager, MedImpact, using one of the drug- or drug-class-specific medication request forms below. You can fax the appropriate MedImpact medication request form to 877-501-1059 or 858-790-7100.
Caremark enrollment forms
To enroll your patient in the Caremark Specialty Program, please fax the enrollment form below to Caremark at 800-323-2445.