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Most prescription drugs are limited to a maximum quantity in a single prescription. Log in to myWellmark to check your benefits to see if a drug is covered. 

  • Drugs indicated as non-formulary cannot be approved through the prior authorization process.
  • Your doctor can request approval using the Global Prior Authorization FormExternal Site. Obtaining the approval in advance will help to prevent delays at the pharmacy.
  • If the drug is approved, the prescription can be filled at any in-network pharmacy.

In addition, coverage for certain drugs is limited to specific quantities per month, benefit year, or lifetime. Amounts in excess of quantity limitations are not covered unless there is prior authorization criteria in place to request additional quantities and approval is granted. Your benefits certificate, coverage manual, or policy has specific information about your plan's prior authorization requirements.

  • Abstral
  • Acanya
  • Aciphex Sprinkles
  • Actemra
  • Acticlate
  • Actiq
  • Aczone
  • Adapalene 0.3%
  • Adcirca
  • Adderall XR
  • Adempas
  • Adoxa
  • Aerospan
  • Afrezza
  • Alsuma
  • Alvesco
  • Ambien CR
  • Amphetamine-Dextroamphetamine ER
  • Androderm
  • Androgel
  • Androgel Pump
  • Apidra
  • Aptensio XR
  • Armodafanil
  • Atralin
  • Aubagio
  • Avita
  • Avinza
  • Avonex
  • Axiron
  • Banzel
  • Beconase AQ
  • Belsomra
  • Benzaclin
  • Benzoyl Peroxide/Clindamycin
  • Berinert
  • Betaseron
  • Bivigam
  • Botox
  • Breo Ellipta
  • Butrans
  • Carac Cream
  • Carimune NF
  • Cialis
  • Cimzia
  • Cinryze
  • Cinqair
  • Clindamycin Foam
  • Clonidine ER
  • Compounded Drug Products
  • Concerta
  • Condylox Gel
  • Copaxone
  • Cosentyx
  • Daklinza
  • Daytrana
  • Desvenlafaxine ER
  • Desvenlafaxine Fumarate ER
  • Dexedrine
  • Dexilant
  • Dexmethylphenidate ER
  • Dextroamphetamine ER
  • Diclofenac Sodium 3% Gel
  • Differin 0.3%
  • Doryx
  • Doxycycline delayed release
  • Duac
  • Duragesic
  • Dymista
  • Dysport
  • Edluar
  • Embeda
  • Enbrel
  • Entresto
  • Entyvio
  • Epclusa
  • Epiduo Forte
  • Epoprostenol
  • Esbriet
  • Esomeprazole Strontium
  • Eszopiclone
  • Euflexxa
  • Evoclin
  • Exalgo
  • Extavia
  • Fentanyl Lozenge
  • Fentanyl transdermal system
  • Fentora
  • Fetzima
  • Firazyr
  • Flebogamma
  • Flolan
  • Flovent
  • Flunisolide Nasal Solution
  • Fluoroplex
  • Fluorouracil 0.5% Cream
  • Fluvoxamine Maleate ER
  • Focalin XR
  • Fortesta
  • Frova
  • Frovatriptan
  • Gammagard
  • Gammaked
  • Gammaplex
  • Gamunex C
  • Gel-One
  • Genotropin
  • Gilenya
  • Glatopa
  • Glucose Test Strips
  • Grastek
  • H.P. Acthar
  • Harvoni
  • Hetlioz
  • Hizentra
  • Humalog
  • Humalog Mix 50/50
  • Humalog Mix 75/25
  • Humatrope
  • Humira
  • Humulin 70/30
  • Humulin N
  • Humulin R-100
  • Hyalgan
  • Hyqvia
  • Hysingla ER
  • Intermezzo
  • Itraconazole
  • Jublia
  • Juxtapid
  • Kadian
  • Kalbitor
  • Kalydeco
  • Kapvay
  • Kazano
  • Kerydin
  • Khedezla
  • Kineret
  • Kombiglyze ER
  • Kuvan
  • Kynamro
  • Lemtrada
  • Letairis
  • Levitra
  • Lunesta
  • Luvox CR
  • Makena
  • Metadate CD
  • Metadate ER
  • Methylphenidate CD
  • Methylphenidate ER
  • Minocycline ER
  • Mirapex ER
  • Modafinil
  • Mometasone Nasal Spray
  • Monovisc
  • Morphine extended-release
  • Morphine extended-release beads
  • Movantik
  • MS Contin
  • Myobloc
  • Nasonex
  • Natesto
  • Nesina
  • Neuac
  • Nexium Capsules
  • Nexium Packets
  • Norditropin
  • Nucala
  • Nucynta ER
  • Nuplazid
  • Nutropin
  • Nutropin AQ
  • Nuvigil
  • Octagam
  • Ofev
  • Olysio
  • Omnaris
  • Omnitrope
  • Onexton
  • Onfi
  • Onglyza
  • Onmel
  • Onsolis
  • Opana ER
  • Opsumit
  • Oracea
  • Oralair
  • Orencia
  • Orenitram
  • Orthovisc
  • Orkambi
  • Oseni
  • Otezla
  • OxyContin
  • Oxymorphone extended-release
  • Pegasys
  • Pexeva
  • Picato
  • Plegridy
  • Praluent
  • Prevacid Solutabs
  • Prilosec Packets
  • Pristiq
  • Privigen
  • Protonix Packets
  • Proventil HFA
  • Provigil
  • Pulmicort Flexhaler
  • Qnasl
  • Qnasl Child
  • Quillivant XR
  • Ragwitek
  • Raloxifene
  • Rebif
  • Relistor
  • Relpax
  • Remicade
  • Remodulin
  • Repatha
  • Requip XL
  • Retin A Micro
  • Retin-A
  • Revatio
  • Rexulti
  • Ritalin LA
  • Rituxan
  • Ropinirole ER
  • Rozerem
  • Ruconest
  • Saizen
  • Savaysa
  • Serostim
  • Sildenafil
  • Silenor
  • Simponi
  • Simponi Aria
  • Solaraze
  • Solodyn
  • Sovaldi
  • Sporanox
  • Staxyn
  • Stelara
  • Stendra
  • Strattera
  • Strensiq
  • Striant
  • Subsys
  • Sumavel Dosepro
  • Supartz
  • Symbicort
  • Synagis
  • Synvisc
  • Synvisc-One
  • Taltz
  • Tamoxifen
  • Tanzeum
  • Tecfidera
  • Technivie
  • Testim
  • Testosterone Gel 1%
  • Testosterone Gel Pump 1%
  • Tracleer
  • Trintellix
  • Tretinoin Micronized topical
  • Tretinoin topical
  • Treximet
  • Trulicity
  • Tysabri
  • Tyvaso
  • Uloric
  • Uptravi
  • Veletri
  • Veltin
  • Ventavis
  • Ventolin HFA
  • Veramyst
  • Veregen Ointment
  • Viagra
  • Viekira Pak
  • Viekira XR
  • Viibryd
  • Vogelxo
  • Vraylar
  • Vyvanse
  • Xartemis XR
  • Xeljanz
  • Xeljanz XR
  • Xeomin
  • Xolair
  • Xopenex HFA
  • Xtampza
  • Xyrem
  • Zecuity
  • Zepatier
  • Zetonna
  • Ziana
  • Zohydro ER
  • Zolpidem Tartrate ER
  • Zolpimist
  • Zomacton
  • Zomig Nasal Spray
  • Zorbtive
  • Zurampic
  • Zyclara