Manage Authorizations

New-to-market drugs

For most benefits, there is an evaluation period before adding new, FDA-approved brand-name prescription drugs to the formulary or to medical coverage after the prescription drug receives an FDA approval. During this evaluation period, the drug will be considered non-covered while the Wellmark Pharmacy & Therapeutics (P&T) Committee reviews the clinical evidence available, including but not limited to, the drug’s safety, efficacy, and place in therapy.

If, following the P&T evaluation, it is determined that a drug should be covered and managed through medical policy or prior authorization, the policy and the drug will be added to the medical authorization table or drug authorization list. The formulary will also be updated.

Refer to our complete list of new-to-market non-covered medications PDF File

Manage medical and drug authorizations

Some medical services, procedures, durable medical equipment (DME) and drugs require approval before they can be covered by your patients' benefits.

Upon receiving approval, you will be given an authorization number. Please reference this number on all claims related to the specific procedure or service requiring prior approval. Also, remember that services determined as not medically necessary, investigational, or experimental are the liability of the provider.