Prior Authorization Requirements for Medicare
Drugs listed on this page require prior authorization from Medicare Advantage.
If you wish to prescribe a drug on this list, click on its name to download the associated prior authorization form in PDF format. Using the appropriate form will help to ensure that we have the information necessary to make a decision about your request.
Please note that there are different prior authorization forms for Medicaid, CHIP and Individual and Family Plans. To access those forms, visit the Medicaid and CHIP and the IFP pages:
Part D Step Therapy Authorization Forms
The following forms are downloadable in PDF format:
| Febuxostat Step Therapy Sancuso Step Therapy Spritam Step Therapy |
Ubrelvy Step Therapy Antipsychotics Brand Step Therapy Nurtec Step Therapy |
Part B Step Therapies
Part B drugs are subject to Step Therapy; our step therapy guidelines are reflected with the document below:
