Pre-authorization for Prescription and Specialty Medications

PEHP has chosen specific prescription drugs and specialty medications to require pre-authorization. These medications were chosen due to their high potential for safety issues, adverse reactions, contraindications, misuse, opportunity to use first line therapy or cost.

To obtain pre-authorization, a member's physician must contact PEHP's Customer Service. The provider will be directed to PEHP's or Medco's pharmacy pre-authorization phone line. Approval or denial will be communicated to the provider's office. Members may also contact PEHP's Customer Service Department for the status of the physician's request. Pre-authorization does not guarantee payment. Coverage is subject to eligibility, benefit coverage and pre-authorization limitations.

Listed below are medications that require prior authorization as well as the administrator of the authorization.

*The pre-authorization list may be subject to change. Members may always contact PEHP's Customer Service Department for prior authorization information on any medication.