Pharmacy Medical Necessity Guidelines

We are introducing new formularies and Pharmacy Medical Necessity Guidelines, effective Jan. 1, 2023. The Pharmacy Medical Necessity Guidelines below detail coverage criteria. You may request authorization in one of the following ways: via PromptPA; use of electronic prior authorization (ePA) through EMR, CoverMyMeds, or Surescripts; or by FAX using the corresponding request forms (available prior to Jan. 1, 2023).