PRIMARY/PREFERRED DRUG LIST (FORMULARY)

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Osborne Strickland
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1 PRIMARY/PREFERRED DRUG LIST (FORMULARY) A ABSTRAL ACANYA ADEMPAS ADVAIR ALBENZA ALPHAGAN P ALREX AMTURNIDE ANDRODERM ANORO ELLIPTA APRISO ARANESP ARCAPTA ASMANEX ATELVIA ATRALIN ATRIPLA AUBAGIO AUVI-Q AVODART AXIRON AZILECT AZOPT AZOR B BD INSULIN SYRINGES & NEEDLES BELVIQ BENICAR BENICAR HCT BENZACLIN BESIVANCE BETASERON BETIMOL BETOPTIC S BEYAZ BIDIL BOSULIF BRILINTA BRINTELLIX BRISDELLE BUTRANS BYSTOLIC C CANASA CETROTIDE CIALIS CIPRODEX CITRANATAL CLODERM COLCRYS COMBIGAN COMBIVENT RESPIMAT COMPLERA CONTRAVE COPAXONE COREG CR CORTIFOAM COSOPT PF CREON CRESTOR CRINONE D DALIRESP DENAVIR DEXCOM CONTINUOUS GLUCOSE MONITORING SYSTEM DEXILANT DICLEGIS DIFFERIN DIFICID DIVIGEL DUAVEE DULERA DUREZOL E EFFIENT ELIDEL ELIQUIS ENBREL ENDOMETRIN EPIDUO EPIPEN EPIPEN JR EPISIL EPZICOM ESTRACE CREAM EVAMIST EVOTAZ EVZIO EXELON PATCH F FARXIGA FENTORA FINACEA FLOVENT DISKUS FLOVENT HFA FLUOXETINE 60 MG FOLLISTIM AQ FORTEO G GELINIQUE GEL-ONE GILENYA GLEEVEC GLUCAGEN HYPOKIT GLUCAGON EMERGENCY KIT GRALISE GRASTEK H HARVONI HUMATROPE HUMIRA HUMULIN R U-500 HYALGAN I ISENTRESS J JANUMET JANUMET XR JANUVIA JARDIANCE JENTADUETO JUBLIA K KHEDEZIA L LANTUS LATUDA LETAIRIS LEVEMIR LIALDA LINZESS LO LOESTRIN FE LOCOID LOTION LOTEMAX LOTRONEX 3 LUZU LYRICA M MEGACE ES MINASTRIN 24 FE MINIVELLE MIRAPEX ER MOVANTIK MOVIPREP MOXEZA MUGARD MUSE MYBETRIQ N NAFTIN NAMENDA NAMENDA XR NASONEX NATAZIA NEUPRO NITROLINGUAL NITROSTAT NORDITROPIN NORVIR NOVOLIN 70/30 NOVOLIN N NOVOLIN R NOVOLOG NOVOLOG MIX 70/30 NUCYNTA NUCYNTA ER NUVARING NUVIGIL O ONETOUCH ULTRA STRIPS & KITS 2 ONETOUCH VERIO STRIPS & KITS 2 OPANA ER OPSUMIT ORACEA ORALAIR ORTHO TRI-CYCLEN LO OSPHENA OVIDREL OXYCONTIN FOR YOUR INFORMATION: Generics should be considered the first line of prescribing. This SignatureScripts primary drug list is not all inclusive nor does it guarantee coverage, but represents a summary of prescription coverage. Specific prescription benefit plan design may not cover categories, regardless of their appearance in this document. The plan participant s prescription benefit plan may have a different copay 1 for specific products on this list. Unless otherwise indicated, drug list products will include all dosage forms. Listed products may be available generically in certain strengths or dosage forms. Dosage forms on this list will be consistent with the category and use where listed. Contact SignatureScripts Customer Service to check coverage and co-payments* for a specific medicine.

2 PRIMARY/PREFERRED DRUG LIST (FORMULARY) P PATADAY PATANOL PAZEO PENTASA PERFOROMIST PHOSLYRA PICATO PRADAXA PREMARIN PREMARIN CREAM PREMPHASE PREMPRO PREZCOBIX PREZISTA PRISTIQ PROAIR HFA PROCRIT PROCTOFOAM -HC PROLENSA PROVENTIL HFA PULMICORT FLEXHALER PYLERA Q QUILLIVANT XR QVAR R RAGWITEK RANEXA RAPAFLO RASUVO REBIF RELPAX RELENZA RENVELA RESTASIS RETIN-A MICRO REYATAZ S SAFRYAL SANCUSO SAVELLA SAXENDA SEREVENT SEROQUEL XR SILENOR SIMBRINZA SIVEXTRO SOOLANTRA SORILUX SOVALDI SPIRIVA SPRYCEL STRATTERA STRIBILD SUBOXONE FILM SUBSYS SUCLEAR SUPARTZ SUPRAX SUPREP SYMLINPEN SYNTHROID T TAMIFLU TAZORAC TECFIDERA TEKAMLO TEKTURNA TEKTURNA HCT TIVICAY TOBRADEX OINTMENT TOBRADEX ST TOUJEO TRACLEER TRADJENTA TRAVATAN Z TRESIBA TREXIMET TRIBENZOR TRIUMUEQ TRULICITY TRUVADA U UCERIS ULORIC ULTRESA V VAGIFEM VELPHORO VENTOLIN HFA VESICARE VICTOZA VIGAMOX VIIBRYD VIMPAT VIOKACE VOLTAREN GEL VYTORIN VYVANSE W WELCHOL X XARELTO XIFIXAN 550 MG XIGDUO XR Z ZENPREP ZETIA ZIOPTAN ZOMIG NASAL SPRAY ZYCLARA ZYLET FOR YOUR INFORMATION: Generics should be considered the first line of prescribing. This SignatureScripts primary drug list is not all inclusive nor does it guarantee coverage, but represents a summary of prescription coverage. Specific prescription benefit plan design may not cover categories, regardless of their appearance in this document. The plan participant s prescription benefit plan may have a different copay 1 for specific products on this list. Unless otherwise indicated, drug list products will include all dosage forms. Listed products may be available generically in certain strengths or dosage forms. Dosage forms on this list will be consistent with the category and use where listed. Contact SignatureScripts Customer Service to check coverage and co-payments* for a specific medicine.

3 j INFORMATION FOR THE PLAN PARTICIPANT Your Benefit Plan provides you with a prescription benefit program that is administered by SignatureScripts. Ask your doctor to consider prescribing, when medically appropriate, a preferred medicine from this list. Take this list along when you or a covered family member sees a doctor. For specific information regarding your prescription benefit coverage and co-pay* information, contact a SignatureScripts customer service representative, toll-free: A OneTouch blood glucose meter will be provided at no charge by the manufacturer to those individuals currently using a meter other than OneTouch. For more information on how to obtain a blood glucose meter, call SignatureScripts Customer Service. The drug list is subject to change. For the most up-to-date list visit SignatureScripts/Caremark may contact your doctor after receiving your prescription to request consideration of a drug list product or generic equivalent. This may result in your doctor prescribing, when medically appropriate, a different brand name product or generic equivalent in place of your original prescription. Generics should be considered the first line of prescribing. The drug list is not all inclusive nor does it guarantee coverage, but represents a summary of prescription coverage. The plan participant's specific prescription benefit plan may have different co-pays for specific products on the list. Unless specifically indicated, drug list products will include all dosage forms. Any brand drug for which a generic product becomes available may be designated as a non-preferred product. The drug list is subject to change. For the most up-to-date list visit For plans with traditional 3-tier co-pays: Tier 1 = All generic medications. Tier 2 = All brand name / formulary medications that appear on this list. Tier 3 = All brand name / non-formulary medications that DO NOT appear on this list. INFORMATION FOR THE HEALTHCARE PROVIDER Your patient is covered under a prescription benefit plan administered by SignatureScripts. As a way to help manage healthcare costs, authorize generic substitution whenever possible. If you believe a brand name product is necessary, consider prescribing a brand listed in this brochure. Healthcare providers may direct questions about the list to a SignatureScripts customer service representative at Thank you for your professional cooperation in providing cost-effective quality healthcare. * Co-payment or co-pay means the amount a plan participant is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan. This SignatureScripts primary / preferred drug list contains prescription brand name medicines that are registered or trademarks of pharmaceutical manufacturers that are not affiliated with SignatureScripts. Listed products are for informational purposes only and are not intended to replace clinical judgment of the prescriber. Your privacy is important to us. Our associates are trained regarding the appropriate way to handle your private health information.

4 Preferred Alternatives List DRUG NAME PREFERRED ALTERNATIVE(S)* DRUG NAME PREFERRED ALTERNATIVE(S)* ABILIFY aripiprazole, clozapine, olanzapine, quetiapine, AXERT naratriptan, rizatriptan, sumatriptan nasal spray, risperidone, ziprasidone, LATUDA, SEROQUEL XR sumatriptan tablet, zolmitriptan, RELPAX, ZOMIG NASAL SPRAY ACCU-CHEK STRIPS ONETOUCH ULTRA STRIPS AND KITS 2 AZELEX adapalene,benzoyl peroxide, clindamycin solution, AND KITS 4 clindamycin-benzoyl peroxide, erythromycin solution, erythromycin benzoyl peroxide, tretinoin, ACANYA, ATRALIN, BENZACLIN, DIFFERIN, EPIDUO, RETIN-A MICRO, TAZORAC ACTOS pioglitazone BECONASE AQ flunisolide, fluticasone, triamcinolone, NASONEX ADDERALL XR amphetamine-dextroamphetamine mixed salts, amphetamine-dextroamphetamine mixed salts ext-rel, guanfacine ext-rel, methylphenidate extrel, QUILLIVANT XR, STRATTERA, VYVANSE BENZAC AC, BENZAC W adapalene, benzoyl peroxide, clindamycin solution, clindamycin-benzol peroxide, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, ACANYA, ATRALIN, BENZACLIN, DIFFERIN, EPIDUO, RETIN-A MICRO, TAZORAC ADRENACLICK AUVI-Q, EPIPEN, EPIPEN JR BENZIQ adapalene, benzoyl peroxide, clindamycin solution, clindamycin-benzol peroxide, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, ACANYA, ATRALIN, BENZACLIN, DIFFERIN, EPIDUO, RETIN-A MICRO, TAZORAC ADVICOR atorvastin, fluvastin, lovastin, pravastatin, BREEZE 2 STRIPS AND KITS 4 ONETOUCH ULTRA STRIPS AND KITS 2 AEROSPAN ASMANEX, FLOVENT DISKUS, FLOVENT HFA, BREO ELLIPTA ADVAIR PULMICORT FLEXHALER, QVAR ALORA estradiol, DIVIGEL,EVAMIST, MINIVELLE BYDUREON TRULICITY, VICTOZA ALTOPREV atorvastatin, fluvastatin, lovastatin, pravastin, BYETTA TRULICITY, VICTOZA ALVESCO ASMANEX, FLOVENT DISKUS, FLOVENT HFA, PULMICORT FLEXHALER, QVAR CARAC fluorouracil cream 5%, fluorouracil solution, imiquimod, PICATO, ZYCLARA AMITIZA LINZESS CARDIZEM diltiazem ext-rel(except generic Cardizem LA) AMRIX cyclobenzaprine CARDIZEM CD diltiazem ext-rel(except generic Cardizem LA) ANDROGEL ANDRODERM, AXIRON CARDIZEM LA diltiazem ext-rel, generic Cardizem LA ANGELIQ estradiol-norethindrone, PREMPHASE, PREMPRO CARDURA XL alfuzosin ext-rel, doxazosin, tamsulosin, terazosin, RAPAFLO ANTARA fenofibrate,fenofibric acid CLINDAGEL erythromycin solution APEXICON E desoximestasone, flucinonide clobetasol spray clobetsol foam APIDRA NOVOLOG CLOBEX SPRAY clobetsol foam ARMOUR THYROID levothyroxine, SYNTHROID CONTOUR NEXT STRIPS AND KITS ONETOUCH ULTRA STRIPS AND KITS 2 ARTHROTEC ASACOL HD ASCENSIA STRIPS & KITS ATACAND, ATACAND HCT celecoxib, diclofenac sodium, meloxicam or naproxen WITH esomeprazole, lansoprazole, omeprazole, omeprazole-sodium bicarbonate capsule, pantoprazole, OR DEXILANT balsalazide, sulfasalazine, sulfasalazine delayedrel, APRISO, LIALDA, PENTASA, UCERIS ONETOUCH ULTRA STRIPS AND KITS 2 CONTOUR STRIPS AND KITS ONETOUCH ULTRA STRIPS AND KITS 2 CYMBALTA duloxetine, venlafaxine, venlafaxine ext-rel, KHEDEZIA, PRISTIQ APRISO, LIALDA, PENTASA, UCERIS DELZICOL balsalazide, sulfasalazine, sulfasalazine delayed-rel, candesartan,, candesartan-hydrochlorothiazide, eprosartan,irbesartan, irbesartanhydrochlorothiazide, losartan, losartanhydrochlorothiazide, telmisartan, telmisartanhydrochlorothiazide, DETROL LA oxybutynin ext-rel, tolterodine, tolterodine ext-rel, trospium, trospium ext-rel, GELNIQUE, MYRBETRIQ, VESICARE ATROVENT HFA SPIRIVA DIOVAN, DIOVAN HCT candesartan, candesartan-hydrochlorothiazide, eprosartan, irbesartan, irbesartanhydrochlorothiazide, losartan, losartanhydrochlorothiazide, telmisartan, telmisartanhydrochlorothiazide, BENICAR, BENICAR-HCT AVONEX AUBAGIO, BETASERON, COPAXONE, GILENYA, DORAL eszopiclone, zolpidem, zolpidem ext-rel, SILENOR REBIF,TECFIDERA DUEXIS celecoxib, diclofenac sodium, meloxicam, naproxen WITH lansoprazole, omeprazole, omeprazole-sodium bicarbonate capsule, pantoprazole, OR DEXILANT

5 Preferred Alternatives List DRUG NAME PREFERRED ALTERNATIVE(S)* DRUG NAME PREFERRED ALTERNATIVE(S)* DYMISTA flunisolide, fluticasone, triamcinolone or NASONEX INTUNIV amphetamine-dextroamphetamine mixed salts, WITH azelastine, or olopatadine amphetamine-dextroamphetamine mixed salts extrel, guanfacine ext-rel, methylphenidate, methylphenidate ext-rel, DAYTRANA, QUILLIVANT XR, STRATTERA, VYVANSE EDARBI,EDARBYCLOR candesartan, candesartan-hydrochlorothiazide, INVOKAMET XIGDUO XR eprosartan, irbesartan, irbesartanhydrochlorthiazide, losartan, losartanhydrochlorthiazide,telmisartan, telmisartanhydrochlorothiazide, EDLUAR eszopiclone, zolpidem, zolipidem ext-rel, SILENOR INVOKANA FARXIGA, JARDIANCE ENABLEX oxybutynin ext-rel, tolterodine, tolterodine ext-rel, ISTALOL timolol maleate solution, BETIMOL trospium, trospium ext- rel, GELNIQUE, MYRBETRIQ, VESICARE ENJUVIA estradiol, estropriate, PREMARIN JALYN finasteride or AVODART WITH alfuzosin ext-rel, doxazosin, tamsulosin, terazosin or RAPAFLO ESTRING ESTRACE CREAM, PREMARIN CREAM, VAGIFEM KAZANO JANUMET, JANUMET XR, JENTADUETO EUFLEXXA GEL-ONE, HYALGAN, SUPARTZ FX KOMBIGLYZE XR JANUMET, JANUMET XR, JENTADUETO EXFORGE amlodipine-telmisartan, amlodipine-valsartan, AZOR LASTACAFT azelastine, cromolyn sodium, PATADAY, PATANOL, PAZEO EXFORGE HCT amlodipine-valsartan-hydrochlorothiazide, TRIBENZOR LESCOL XL atorvastatin, fluvastatin, lovastatin, pravastatin, EXTAVIA AUBAGIO, BETASERON, COPAXONE, GILENYA, LEVITRA CIALIS REBIF, TECFIDERA FEMRING ESTRACE CREAM, PREMARIN CREAM, VAGIFEM LIPITOR atorvastatin, fluvastatin, lovastatin, pravastatin, FETZIMA duloxetine, venlafaxine, venlafaxine ext-rel, KHEDEZLA, PRISTIQ LIPTRUZET atorvastatin, fluvastatin, lovastatin, pravastatin, FIRST TESTOSTERONE ANDRODERM, AXIRON LIVALO atorvastatin, fluvastatin, lovastatin, pravastatin, fluorouracil cream % fluorouracil cream 5%, fluorouracil solution, LUMIGAN latanoprost, travoprost, TRAVATAN Z, ZIOPTAN imiquimod, PICATO, ZYCLARA FORTAMET metformin, metformin ext-rel LUNESTA eszopiclone, zolpidem, zolpidem-ext-rel, SILENOR FORTESTA ANDRODERM, AXIRON MENEST estradiol, estropipate, PREMARIN FOSAMAX PLUS D alendronate, ibandronate,actonel, ATELVIA MENOSTAR estradiol FOSRENOL calcium acetate, PHOSLYRA, RENVELA, VELPHORO MICARDIS, MICARDIS HCT candesartan,candesartan-hydrochlorothiazide, eprosartan, irbesartan, irbesartanhydrochlorothiazide, losartan, losartanhydrochlorothiazide, telmisartan, telmisartanhydrochlorothiazide, FREESTYLE STRIPS ONETOUCH ULTRA STRIPS AND KITS 2 MONOVISC GEL-ONE, HYALGAN, SUPARTZ FX AND KITS FROVA naratriptan, rizatriptan, sumatriptan nasal spray, NAPRELAN celecoxib, diclofenac sodium, meloxicam, naproxen sumatriptan tablet, zolmitriptan, RELPAX, ZOMIG NASAL SPRAY GENOTROPIN HUMATROPE, NORDITROPIN NATESTO ANDRODERM, AXIRON GLUMETZA metformin, metformin ext-rel NESINA JANUVIA, TRADJENTA HUMALOG NOVOLOG NITROMIST nitroglycerin sublingual spray, NITROLINGUAL, NITROSTAT HUMALOG MIX 50/50 NOVOLOG MIX 70/30 NORITRATE metronidazole, sulfacetamide-sulfur, FINACEA, SOOLANTRA HUMALOG MIX 75/25 NOVOLOG MIX 70/30 NORVASC amlodipine HUMULIN NOVOLIN NUTROPIN AQ HUMATROPE, NORDITROPIN INCRUSE ELLIPTA SPIRIVA OLEPTRO trazodone INNOPRAN XL atenolol, carvedilol, metoprolol, metoprolol OLUX-E clobetasol foam succinate ext-rel, metroprolol tartrate, nadolol, propranolol, propranolol ext-rel, BYSTOLIC, COREG CR INTERMEZZO eszopiclone, zolpidem, zolpidem ext-rel, SILENOR OMNARIS flunisolide, fluticasone, triamcinolone, NASONEX ONGLYZA JANUVIA, TRADJENTA OMNITROPE HUMATROPE, NORDITROPIN

6 Preferred Alternatives List DRUG NAME PREFERRED ALTERNATIVE(S)* DRUG NAME PREFERRED ALTERNATIVE(S)* SURE-TEST STRIPS AND ONETOUCH ULTRA STRIPS AND KITS 2 KITS ORTHOVISC GEL-ONE, HYALGAN, SUPARTZ FX SYMBICORT ADVAIR, DULERA OSENI JANUMET, JANUMET XR, JENTADUETO SYNVISC, SYNVISC ONE GEL-ONE, HYALGAN, SUPARTZ OXYTROL oxybutynin ext-rel, tolterodine, tolterodine ext-rel, TANZEUM TRULICITY, VICTOZA trospium, trospium ext-rel, GELNIQUE, MYRBETRIQ, VESICARE PANCREAZE CREON, ULTRESA, VIOKACE, ZENPREP testerone gel 1% ANDRODERM, AXIRON PENNSAID diclofenac sodium, diclofenac sodium solution, TESTIM ANDRODERM, AXIRON meloxicam, naproxen, VOLTAREN GEL PERTZYE CREON, ULTRESA, VIOKACE, ZENPREP TEVETEN, TEVETEN-HCT candesartan, candesartanhydrochlorothiazide,eprosartan,irbesartan,irbesartanhydrochlorothiazide, losartan, losartanhydrochlorothiazide,telmisartan, telmisartan hydrochlorothiazide, PEXEVA citalopram, escitalopram, fluoxetine, paroxetine, paroxetine ext-rel, sertraline, BRINTELLIX, FLUOXETINE 60 MG, VIIBRYD TOVIAZ oxybutynin ext-rel, tolterodine ext-rel, trospium, trospium ext-rel, GELNIQUE,MYRBETRIQ, VESICARE PLAVIX clopidogrel, BRILINTA, EFFIENT TRICOR fenofibrate, fenofibric acid PLEGRIDY AUBAGIO, BETASERON, COPAXONE, GILENYA, TRIGLIDE fenofibrate, fenofibric acid REBIF, TECFIDERA PRECISION XTRA ONETOUCH ULTRA STRIPS AND KITS 2 TRILIPIX fenofibrate, fenofibric acid STRIPS AND KITS 4 PRED MILD dexamethasone, DUREZOL,LOTEMAX TRUETEST STRIPS AND KITS 4 ONETOUCH ULTRA STRIPS AND KITS 2 PREFERAOB generic prenatal vitamins, CITRANATAL TRUETACK STRIPS AND KITS 4 ONETOUCH ULTRA STRIPS AND KITS 2 PREFEST estradiol-norethindrone, PREMPHASE, PREMPRO TUDORZA SPIRIVA PRENATAL PLUS generic prenatal vitamins, CITRANATAL VALCYTE valganciclovir PREVACID esomeprazole, lansaprazole, omeprazole, VALTREX acyclovir, valacyclovir omeprazole-sodium bicarbonate capsule, pantoprazole, DEXILANT PROTONIX lansaprazole, omeprazole, omeprazole-sodium VANOS clobetasol cream, clobetasol lotion bicarbonate capsule, pantoprazole, DEXILANT PROTOPIC tacrolimus, ELIDEL VASCEPA omega-3 acid ethyl esters QNASL flunisolide, fluticasone, triamcinolone, NASONEX VERAMYST flunisolide, fluticasone, triamcinolone, NASONEX QSYMIA BELVIQ, CONTRAVE, SAXENDA VIAGRA CIALIS RAYOS dexamethasone, methylprednisolone, prednisone VIEKIRA PAK HARVONI RELION INSULIN NOVOLIN INSULIN VIMOVO celecoxib; diclofenac sodium, meloxicam, or naproxen WITH esomeprazole, omeprazole, omeprazole-sodium bicarbonate capsule, pantoprazole, DEXILANT RELISTOR MOVANTIK VITAFOL-ONE generic prenatal vitamins, CITRANATAL RHINOCORT AQUA flunisolide, fluticasone, triamcinolene, NASONEX VOGELXO ANDRODERM, AXIRON RIOMET metformin, metformin ext-rel XOPENEX HFA PROAIR HFA, PROVENTIL HFA, VENTOLIN HFA ROZEREM eszopiclone, zolpidem, zolpidem ext-rel, SILENOR ZETONNA flunisolide, flucasone, triamcinolone, NASONEX SAIZEN HUMATROPE, NORDITROPIN ZUBSOLV buprenorphine-nalomone sublingual tablet, SUBOXONE FILM SKELID alendronate,risedronate ZYFLO, ZYFLO CR montelukast, zafirlukast STRIANT ANDRODERM, AXIRON 1 Higher co-payments* may apply depending on the plan participant s specific prescription benefit plan. Call SignatureScripts to find the co-payment under a specific plan. 2 A OneTouch blood glucose meter will be provided at no charge by the manufacturer to those individuals currently using a meter other than OneTouch. For more information on how to obtain a blood glucose meter, call SignatureScripts Customer Service at Amedical exception process is in place for specific clinical circumstances that may require continued coverage for one of these specific drugs: Freestyle diabetic test strips. If your doctor believes you have a specific clinical need for one of these drugs, he or she should fax a medical exception request to OneTouchbrand test strips are the only preferred options. Note: Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. Contact SignatureScripts Customer Service to check coverage and co-pays for a specific medicine. *The preferred alternative products in this list are a broad representation within therapeutic categories of available treatment options and do not necessarily represent clinical equivalency. Your specific prescription benefit plan design may not cover certain products, regardless of their appearance in this document. For specific information, visit or contact a SignatureScripts Customer Service Representative. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber.

Medications Requiring Prior Authorization for Medical Necessity

Medications Requiring Prior Authorization for Medical Necessity Medications Requiring Prior Medical Necessity January 2016 Below is a list of medicines by drug class that will not be covered without a prior authorization for medical necessity. If you continue using