Drugs Requiring Prior Approval

Some prescription drugs may require certification, also known as prior authorization, in order to be covered. These drugs have detailed criteria that must be met before prior authorization can be granted.

If the drug you are looking for is not listed in the chart below, please check Drugs Requiring Step Therapy and Drugs Subject to Quantity Limits.  Below is a chart of the drugs and drug classes that require prior authorization, the prior authorization policies and the fax forms:

Drugs Requiring Prior Authorization
Prior Authorization Policies
Prior Authorization Review Form
Alpha Interferons
Antifungal Agents
Antinarcoleptic Agents

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Drugs Requiring Prior Authorization
Prior Authorization Policies
Prior Authorization Review Form
COX2 Inhibitors
Fentanyl
Fertility Agents
Growth Stimulating Drugs
Immunomodulators
Multiple Sclerosis Agents
Omalizumab
Psoriasis Treatment Agents

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Drugs Requiring Prior Authorization
Prior Authorization Policies
Prior Authorization Review Form
Rheumatoid Arthritis Agents
Sildenafil and Tadalafil
*These drugs may be covered under the pharmacy or medical benefit. If it is covered under the pharmacy benefit, contact Medco for prior approval. If it is covered under the medical benefit, contact Blue Cross and Blue Shield of North Carolina for approval.