In order to help assure our members have access to safe, effective drug therapy and to protect against inappropriate use and waste, we require prior authorization and step therapy* on selected prescription medications.

Prior Authorization & Step Therapy Requirements

• Commercial 3-Tier Prior Authorization and Step Therapy Medication ListOpen a PDF
• Child Health Plus Prior Authorization and Step Therapy Medication ListOpen a PDF
• Medicaid Managed Care Prior Authorization and Step Therapy Medication ListOpen a PDF
• Specialty Rx Medication List (Self-Administered Drugs)Open a PDF
• Provider-Administered Medical Specialty Drugs Requiring Preauthorization - Commercial, Exchange and Medicare Managed CareOpen a PDF
• Provider-Administered Medical Specialty Drugs Requiring Preauthorization - Medicaid Managed Care and Child Health PlusOpen a PDF

Request Approval Online with Electronic Prior Auth (ePA)

You and your staff can request a coverage determination electronically, directly from your electronic medical record (EMR) or through CoverMyMeds ePA Portal.

With ePA:

• You can submit requests for PA prospectively
• You can renew Prior Authorizations 60 days prior to expiration
• ePA through CoverMyMeds is free
• Any authorized personnel can use ePA

Request Approval by Fax or Eform

  Prior Authorization Fax Request Forms

 Send Coverage Determination Request via Secure Eform