Preauthorzation

Click here for information on referrals and the list of services that require preauthorization.

Prescription Drugs Requiring Preauthorization

Please use our Medication Preauthorization Form for the following medications:

  • Actemra
  • Acthar
  • Antiarrhythmic Drug
  • Antihemophilic
  • Botox
  • Entyvio
  • Epogen
  • Fasenra
  • General Medication Policy
  • Interferon
  • Lemtrada
  • Lupron
  • Nucala
  • Ocrevus
  • Orencia
  • Prolia
  • Renflexis
  • Rituxan
  • Simponi Aria
  • Soliris
  • Stellara
  • Xolair

Additional Prescription Drug Policies & Preauthorization Forms