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Drug Authorization and Quantity Limits

Some drugs, and certain amounts of some drugs, require an approval before they can be covered by your patients' benefits.

 

Obtain approval in advance to help prevent delays at the pharmacy.

 

To view authorization information for procedures, imaging, and durable medical equipment (DME), please view the medical authorization table.

 

View important details about authorization

 

FEP Drug Authorization Table

 

The drugs listed below require authorization. Click the drug name to see the criteria of the policy.

 

Submit drug authorization request

 

All Opioid-related drugs 

To find a specific drug more quickly, use the keyboard shortcut. On a PC, press ‘CTRL+‘F’ and on a Mac, press 'Cmd+F' and type in the drug name to search.

 

Abstral
Acanya
Aciphex Sprinkles
Actemra
Acticlate
Actiq
Aczone
Adapalene 0.3%
Adcirca
Adderall XR
Adempas
Admelog
Adoxa
Adzensys XR-ODT
Aerospan
Afrezza
Aimovig
AirDuo RespiClick (BRAND ONLY)
Ajovy
Albuterol Sulfate HFA
Almotriptan
Alsuma
Alvesco
Amphetamine-Dextroamphetamine ER
Androderm
Androgel
Androgel Pump
Apidra
Aptensio XR
Aralast NP
Armodafanil
Atralin
Aubagio
Avita
Avonex
Axert
Axiron
Banzel 
Baraclude solution
Basaglar
Beconase AQ
Belsomra
Benzaclin
Benzoyl Peroxide/Clindamycin
Berinert
Betaseron
Bivigam
Botox
Carac Cream
Carimune NF
Carospir
Cerdelga

Cerezyme
Cimzia
Cinryze
Cinqair
Clindamycin Foam
Compounded Drug Products
Concerta
Condylox Gel
Copaxone
Cosentyx
Cotempla XR
Crysvita
Cutaquiq
Cuvitru
Cuvposa
Cystic Fibrosis
Daklinza
Daytrana
Desvenlafaxine ER
Desvenlafaxine Fumarate ER
Dexedrine
Dexilant
Dexmethylphenidate ER
Dextroamphetamine ER
Diacomit
Differin 0.3%
Doryx
Doxycycline delayed release
Duac
Dupixent
Durolane
Dyanavel XR
Dymista
Dysport
Edluar
Elelyso
Emflaza
Emgality
Emtriva
Enbrel
Entresto
Entyvio
Epaned
Epclusa
Epidiolex
Epiduo Forte
Epoprostenol
Esbriet
Esomeprazole Strontium
Eucrisa
Euflexxa
Evekeo
Evekeo ODT
Evoclin
Extavia
Farxiga
Fasenra
Fentanyl Lozenge
Fentora
Fetzima
Firazyr
Firvanq
Flebogamma
Flolan
FloLipid
Flovent
Flunisolide Nasal Solution
Fluoroplex
Fluorouracil 0.5% Cream
Fluvoxamine Maleate ER
Focalin XR
Forteo
Fortesta
Frova
Frovatriptan
Galafold
Gammagard
Gammaked
Gammaplex
Gamunex C
Gel-One
Gelsyn-3
Genotropin
Genvisc 850
Gilenya
Glassia
Glatopa
Glucose Test Strips

Granix
Grastek
H.P. Acthar
Harvoni
Haegarda
Hetlioz
Hizentra
Humalog
Humalog Mix 50/50
Humalog Mix 75/25
Humatrope
Humira
Humulin 70/30
Humulin N
Humulin R-100
Hyalgan
Hymovis
Hyqvia
Ilumya
Inflectra
Ingrezza
Intermezzo
Itraconazole
Ixifi
Jentadueto
Jublia
Juxtapid
Jynarque
Kalbitor
Kalydeco
Kerydin
Kevzara
Khedezla
Kineret
Kombiglyze ER
Kynamro
Lartruvo
Lemtrada
Letairis
Leukine
Levemir
Lucemyra
Luvox CR
Luxturna
Lyrica solution
Mavyret
Metadate CD
Metadate ER
Methylphenidate CD
Methylphenidate ER
Minocycline ER
Mirapex ER
Modafinil
Mometasone Nasal Spray
Monovisc
Motegrity
Movantik
Mydayis
Myobloc
Naprosyn suspension
Naproxen suspension
Nasonex
Natesto
Neuac

Neupogen
Nexium Capsules
Nexium Packets
Norditropin
Nucala
Nutropin
Nutropin AQ
Nuvigil
Ocaliva
Ocrevus
Octagam
Odactra
Ofev
Olumiant
Olysio
Omnaris
Omnitrope
Onexton
Onfi
Onglyza
Onmel
Onpattro
Onsolis
Opdivo
Opsumit
Oracea
Oralair
Orencia
Orenitram
Orilissa
Orkambi
Orthovisc
Otezla
Oxervate
Palynziq
Patanase
Panzyga
Pegasys
Pexeva
Picato
Plegridy
Pradaxa
Praluent
Prevacid Solutabs
Prilosec Packets
Pristiq
Privigen
Prolastin-C
Protonix Packets
Proventil
Provigil
Pulmicort Flexhaler
Purixan
Qbrelis
Qnasl
Qnasl Child
Qtern
QuilliChew ER
Quillivant XR
Radicava
Ragwitek
Raloxifene
Ravicti
Rebif
Relistor
Relpax
Remicade
Remodulin
Renflexis
Repatha
Requip XL
Retin A Micro
Retin-A
Revatio
Rexulti
Riomet
Ritalin LA
Rituxan
Rituxan Hycela
Ropinirole ER
Rozerem
Ruconest
Ruzurgi
Saizen
Sandostatin LAR
Savaysa
Segluromet
Serostim
Signifor LAR
Sildenafil
Silenor

Siliq
Simponi
Simponi Aria
Solodyn
Soltamox
Sotylize
Sovaldi
Spinraza
Sporanox
Steglatro
Stelara
Strensiq
Striant
Subsys
Sumavel Dosepro
Supartz
Symbicort
Symdeko
Sympazan
Symproic
Synagis
Syndros
Synvisc
Synvisc-One
Takhzyro
Taltz
Talzenna
Tamoxifen
Tanzeum
Targadox
Tavalisse
Tecfidera
Technivie
Tegsedi
Testim
Testosterone Gel 1%
Testosterone Gel Pump 1% 
Tolak
Tolsura
Tracleer
Tradjenta
Tremfya
Tresiba
Tretinoin Micronized topical
Tretinoin topical
Treximet
Trintellix
Trivisc
Trulicity
Truvada
Truxima
Tymlos
Tysabri
Tyvaso
Uptravi
Vancocin
Vancomycin
Veletri
Veltin
Ventavis
Ventolin
Veramyst
Veregen Ointment
Viekira Pak
Viekira XR
Viibryd
Viread
Visco-3
Vogelxo
Vosevi
VPRIV
Vraylar
Vyvanse
Xatmep
Xeljanz
Xeljanz XR
Xeomin
Xigduo XR
Ximino
Xolair
Xyrem
Yervoy
Zavesca
Zecuity
Zemaira
Zepatier
Zetonna
Ziana
Zolpimist
Zomacton
Zomig Nasal Spray
Zorbtive
Zyclara


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