In some cases*, we require you to first try certain “preferred” drugs to treat your medical condition before we will cover another “non-preferred” drug for that condition. For example, if a preferred and non-preferred drug both treat your medical condition, we may not cover the non-preferred drug unless you try the preferred drug first. If the preferred drug does not work for you, we will then cover the non-preferred drug.
All non-preferred drugs require prior authorization to ensure safe and effective use. The prior authorization criteria are consistent with Medicare requirements defined in CMS National Coverage Determinations (NCDs) and relevant Local Coverage Determinations (LCDs).
*Applies to members who are new to therapy.
View our 2023 preferred drug list.