Utilization Management

Utilization management tools, such as prior authorization, quantity limits and step therapy, apply to select drugs to ensure safe and cost-effective use of drugs on the plan's drug list.

Your doctor can submit the forms listed below using MyPrime or CoverMyMeds®.

Prior Authorization

Prior authorization is required on some medications. This means that specific criteria must be met before a drug is covered.

Prior Authorization Criteria and Form

Quantity Limits

Quantity limits are applied to certain drugs based on the approved dosing limits established during the Food and Drug Administration (FDA) approval process. Quantity limits are applied to the number of units dispensed for each prescription.

Quantity Limits Exception Form

Step Therapy

Step therapy requires that you first try certain drugs to treat your medical condition before we will cover another drug for that condition.

Step Therapy Criteria and Form

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