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Prescription Drug List (PDL)


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Preauthorization

Preauthorization

For drugs requiring preauthorization, please call the phone number on the back of your ID card.

For a brief listing of drugs that may have prior authorization requirements or drugs that require other special conditions be met, please refer to the following document:

Drugs With Special Rules - Advantage PDL (7/1/17 - 12/31/17)
Drugs With Special Rules - Traditional PDL (7/1/17 - 12/31/17)

Drugs With Special Rules - Advantage PDL (1/1/17 - 6/30/17)
Drugs With Special Rules - Traditional PDL (1/1/17 - 6/30/17)