MedicareRx: Prescription Drug Coverage
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Prior Authorization Drugs
For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. This ensures that our members use these drugs in a safe way. It also helps to control costs for everyone!
We require you to get prior authorization (prior approval) before certain drugs will be covered under the plan. This means that your doctor or health care provider will need to contact us before you fill your prescription.
Without the necessary information on the Prior Authorization Form, we may not cover the drug.
Step Therapy Drugs
In some cases, we require you to first try one drug to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may require your doctor to prescribe Drug A first. If Drug A does not work for you, then we will cover Drug B.
To see if one or more of the drugs you are taking requires prior authorization or step therapy, type the name of the drug in the Look-Up box below. If a drug you are taking requires prior authorization or step therapy from the Plan, please download and complete a Prior Authorization Form and ask your doctor or other prescriber to fax it to us at 1-855-633-7673.
If you would like a printable Prior Authorization Criteria or Step Therapy document, click:
Prior Authorization Plus Criteria
Prior Authorization Value Criteria
Step Therapy Plus Criteria
Step Therapy Value Criteria
If you need to download a free copy of Adobe Reader, please scroll to the bottom of the page.
To find out if the drug you take is subject to these additional requirements or limits, look in your printed formulary booklet, on our Web site (please choose the plan you are in), or Contact Us.
The information on this page is currently under review and may be updated. Please check back later for updates or Contact Us for information on your drugs.
PA PLUS FORMULARY ONLY
ST PLUS FORMULARY ONLY
This plan is offered by SilverScript Insurance Company, which has a Medicare contract.
Enrollment depends on contract renewal.
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SilverScript Insurance Company, a Medicare approved Part D sponsor, is a subsidiary of CVS Caremark.†
† Other pharmacies are available in our network.
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