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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
Aciphex Sprinkles
Actemra
Acthar Gel
Actiq
Aczone
Adakveo
Adapalene 0.3%
Adcirca
Adderall XR
Addyi
Adempas
Admelog
Adoxa
Adzensys XR-ODT
Aerospan
Afrezza
Aimovig
AirDuo (BRAND ONLY)
Ajovy
Aklief
Alinia
Alkindi Sprinkles
Almotriptan
Alsuma
Altreno
Alvesco
Amitiza (BRAND ONLY)
Amphetamine-Dextroamphetamine ER
Amzeeq
Androderm
Androgel
Androgel Pump
Apidra
Aptensio XR
Aralast NP
Arazlo
Aripiprazole oral solution
Armodafanil
ArmonAir
Asceniv
Atralin
Aubagio
Avastin
Avita
Avonex
Avsola
Axert
Axiron
Azelex
Bafiertam
Banzel
Baraclude solution
Beconase AQ
Belsomra
Benzaclin
Benzoyl Peroxide/Clindamycin
Berinert
Betaseron
Bivigam
Botox
Breztri Aerosphere
Bronchitol
Budesonide/Formoterol Fumarate Inhalation
Caplyta
Carac Cream
Carimune NF
Carospir
Cerdelga
Cerezyme
Cimzia
Cinryze
Cinqair
Citalopram oral solution
Clindamycin Foam
Clindamycin phosphate/tretinoin topical
Compounded Drug Products
Concerta
Condylox Gel
Copaxone
Corlanor
Cosentyx
Cotempla XR
Crysvita
Cutaquiq
Cuvitru
Cuvposa
Cystic Fibrosis
Daytrana
Dayvigo
Descovy
Desvenlafaxine ER
Desvenlafaxine Fumarate ER
Dexedrine
Dexilant
Dexmethylphenidate ER
Dextroamphetamine ER
Diacomit
Differin 0.3%
Dificid Oral Suspension
Dimethyl Fumarate
Dojolvi
Doryx
Doxycycline delayed release
Doxycycline Hyclate delayed release tablet
Drizalma Sprinkles
Duac
Dulera
Dupixent
Durolane
Dyanavel XR
Dymista
Dysport
Edluar
Elelyso
Emflaza
Emgality
Enbrel
Enspryng
Entresto
Entyvio
Epaned
Epclusa
Epidiolex
Epiduo Forte
Epogen
Epoprostenol
Esbriet
Esomeprazole Strontium
Eucrisa
Euflexxa
Evekeo
Evekeo ODT
Evenity
Evkeeza
Evoclin
Evrysdi
Extavia
Eysuvis
Fasenra
Fentanyl Lozenge
Fentora
Fetzima
Finacea 15% foam
Fintepla
Firazyr
Firvanq
Flebogamma
Flector
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
Givlaari
Glassia
Glatopa
Gloperba
Glucose Test Strips
Gocovri
Granix
Grastek
Harvoni
Haegarda
Herceptin
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
Imcivree
Inbrija
Increlex
Indocin oral solution
Inflectra
Ingrezza
Intermezzo
Invokamet
Invokamet XR
Invokana
Isturisa
Itraconazole
Ivermectin
Jentadueto
Jublia
Juxtapid
Jynarque
Kalbitor
Kalydeco
Kazano
Kerydin
Kesimpta
Kevzara
Khedezla
Kineret
Klisyri
Kombiglyze ER
Korlym
Koselugo
Krystexxa
Kynmobi
Lantus
Lemtrada
Letairis
Leukine
Lucemyra
Lupkynis
Luvox CR
Luxturna
Lyrica solution
Lyumjev
Mavenclad
Mavyret
Mayzent
Memantine oral solution
Metadate CD
Metadate ER
Methitest
Methylphenidate CD
Methylphenidate ER
Methyltestosterone
Minocycline ER
Mirapex ER
Mircera
Mirvaso
Modafinil
Mometasone Nasal Spray
Monovisc
Motegrity
Movantik
Mycapssa
Mydayis
Myfembree
Myobloc
Namenda oral solution
Naprosyn suspension
Naproxen suspension
Nasonex
Natesto
Nayzilam
Nesina
Neuac
Neulasta
Neulasta Onpro
Neupogen
Neupro
Nexium Capsules
Nexium Packets
Nexletol
Nexlizet
Norditropin
Nortriptyline oral solution
Nourianz
Nucala
Nurtec ODT
Nutropin
Nutropin AQ
Nuvigil
Ocaliva
Ocrevus
Octagam
Odactra
Ofev
Olumiant
Omnaris
Omnitrope
Onexton
Onfi
Ongentys
Onglyza
Onmel
Onpattro
Onsolis
Opdivo
Opsumit
Oracea
Oralair
Orencia
Orenitram
Oriahnn
Orilissa
Orkambi
Orladeyo
Orthovisc
Oseni
Osmolex ER
Otezla
Oxbryta
Oxervate
Oxlumo
Ozobax
Palforzia
Palynziq
Panzyga
Pazeo
Pegasys
Pennsaid 2% solution
Pexeva
Picato
Plegridy
Ponvory
Pradaxa
Praluent
Prevacid Solutabs
Prilosec Packets
Pristiq
Privigen
Procrit
Prolastin-C
Protonix Packets
Provigil
Pulmicort Flexhaler
Purixan
Qbrelis
Qelbree
Qnasl
Qnasl Child
Qtern
QuilliChew ER
Quillivant XR
Rabeprazole
Radicava
Ragwitek
Raloxifene
Rapamune oral solution
Ravicti
Rebif
Reblozyl
Relistor
Relpax
Remicade
Remodulin
Renflexis
Repatha
Requip XL
Retin A Micro
Retin-A
Revatio
Rexulti
Reyvow
Rhofade
Riabni
Rinvoq
Riomet
Riomet ER
Risperidal oral disintegrating tablet
Risperdal oral solution
Risperidone oral disintegrating tablet
Risperidone oral solution
Ritalin LA
Rituxan
Rituxan Hycela
Ropinirole ER
Rozerem
Ruconest
Ruxience
Ruzurgi
Rytary
Saizen
Samsca
Savaysa
Scenesse
Secuado
Segluromet
Semglee
Serostim
Signifor LAR
Sildenafil
Silenor
Siliq
Simponi
Simponi Aria
Simvastatin Oral Suspension
Skyrizi
Sodium Hyaluronate
Sogroya
Soliris
Solodyn
Soltamox
Somavert
Soolantra
Sotylize
Sovaldi
Spinraza
Sporanox
Spravato
Steglatro
Steglujan
Stelara
Strensiq
Striant
Subsys
Sumavel Dosepro
Sunosi
Supartz
Symdeko
Sympazan
Symproic
Synagis
Syndros
Synojoynt
Synvisc
Synvisc-One
Takhzyro
Taltz
Talzenna
Tamoxifen
Tanzeum
Tasmar
Tavalisse
Tecfidera
Tegsedi
Tepezza
Teriparatide
Testim
Testosterone Gel 1%
Testosterone Gel Pump 1% 
Tolak
Tolsura
Tolvaptan
Tosymra
Toujeo
Tracleer
Tradjenta
Tremfya
Tretin-X
Tretinoin Micronized topical
Tretinoin topical
Treximet
Trikafta
Triluron
Trintellix
Trivisc
Trulicity
Truxima
Turalio
Tymlos
Tysabri
Tyvaso
Ubrelvy
Ultomiris
Uplizna
Uptravi
Valtoco
Vancocin
Vancomycin
Vascepa
Veklury
Veletri
Veltin
Ventavis
Veramyst
Veregen Ointment
Verquvo
Vesicare
Viekira Pak
Viibryd
Visco-3
Vogelxo
Vosevi
VPRIV
Vraylar
Vumerity
Vyepti
Vyleesi
Vyndamax
Vyndaqel
Vyvanse
Wakix
Winlevi
Xadago
Xatmep
Xcopri
Xeljanz
Xeljanz Oral Solution
Xeljanz XR
Xembify
Xeomin
Xiaflex
Ximino
Xolair
Xyosted
Xyrem
Xywav
Yervoy
Zavesca
Zecuity
Zelapar
Zelnorm
Zemaira
Zepatier
Zeposia
Zerviate
Zetonna
Ziana
Zilxi
Zokinvy
Zolgensma
Zolpimist
Zomacton
Zomig Nasal Spray
Zorbtive
Zulresso
Zyclara

 


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