Prior Authorization Form: Your prescription may need prior authorization to assure appropriate use for high-risk or high-cost drugs. Prior Authorization criteria are used to make sure your medication is safe, cost effective, and medically necessary.
Your doctor may need to fill out a prior authorization if your drug is generally used for a certain health condition, has the potential to be misused, or has an age or quantity limit.
Medical Necessity Form: Your doctor can complete a medical necessity form if you take non-formulary drugs, which are often a higher cost. If your doctor can establish medical necessity for these drugs, you can get the drug at the formulary (brand) copayment.
Brand Name Request Form: A generic drug contains the same chemical as the brand-name drug but has a lower copayment. If your doctor determines it is medically necessary for you to take the brand-name drug over the generic version, your doctor can request through the Brand Name Request Form. You may pay additional costs for the brand-name drug.