Prior Authorization

Certain drugs require prior authorization from the plan. If your physician prescribes any medication with a prior authorization requirement, he or she must contact Prime Therapeutics by calling (888) 272-1346 to receive prior authorization before you fill your prescription. In some cases you may be required to submit a letter from your physician verifying the medical necessity of the prescribed drug. After the initial approval, prior authorization may be required again periodically.

To see if your medication requires prior authorization, please refer to the Formulary. Medications that require prior authorization will be designated with “PA” in the Requirements/Limitations column. 

If your request for prior authorization has been denied, you have the option to appeal.