Prior Authorization & Quantity Limits
Some drugs, and certain amounts of some drugs, require an approval before they can be covered by your benefits. This process is called prior authorization.
Most prescription drugs are limited to a maximum quantity in a single prescription. Log in to myWellmark® to see your benefits and 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 Form External 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. Federal regulations limit the quantity that may be dispensed for certain medications. If your prescription is so regulated, it may not be available in the amount prescribed by your doctor. Your benefits certificate, coverage manual, or policy has specific information about your plan's prior authorization requirements.
Prior authorization and quantity limit drug list
To find if your drug requires prior authorization or has quantity limits, please use the Formulary Drug List Tool with the links below.
Blue Rx Basic℠ External Site
Blue Rx Complete℠ External Site
Blue Rx Essentials℠ External Site
Blue Rx Preferred℠ External Site
Blue Rx Value℠ External Site
Blue Rx Value Plus℠ External Site
BlueSimplicity℠ Rx External Site