Utilization Management
Prior Authorization and Step Therapy Policies for Commercial and Individual Family Business (IFB)
Certain drugs within policies may not be applicable to the specific formulary and plan design. Please refer to the formulary drug list and/or member plan documents to determine coverage status.
| Testosterone (Oral, Topical, and Nasal) Products PA Policy | Policy |
| Tetracyclines (Oral) Step Therapy | Policy |
| Thrombocytopenia - Doptelet PA Policy | Policy |
| Thrombocytopenia - Eltrombopag Products PA | Policy |
| Thrombocytopenia - Eltrombopag Products PSM | Policy |
| Thrombocytopenia - Eltromboppag Products PA | Policy |
| Tolvaptan Products - Jynarque PA Policy | Policy |
| Tolvaptan Products - Tolvaptan (Jynarque) PA Policy | Policy |
| Tolvaptan Products - Tolvaptan (Jynarque) PSM | Policy |
| Tolvaptan Products - Tolvaptan (Samsca) PA Policy | Policy |
| Topical Acne - Cleansers Step Therapy Policy | Policy |
| Topical Acne - Kits Step Therapy Policy | Policy |
| Topical Acne - Topical Products Step Therapy Policy | Policy |
| Topical Acyclovir Products PA Policy | Policy |
| Topical Agents for Atopic Dermatitis Step Therapy Policy | Policy |
| Topical Alpha-Adrenergic Agonists for Rosacea - Rhofade PA | Policy |
| Topical Antibacterials Step Therapy | Policy |
| Topical Antifungals for Onychomycosis Step Therapy Policy | Policy |
| Topical Antifungals for Seborrheic Dermatitis Step Therapy | Policy |
| Topical Corticosteroids Step Therapy Policy | Policy |
| Topical Diclofenac Sodium 3% Gel PA | Policy |
| Topical Doxepin Step Therapy Policy | Policy |
| Topical Medications for Inflammatory Rosacea Step Therapy | Policy |
| Topical Podofilox Products Step Therapy Policy | Policy |
| Topical Products - Vtama and Zoryve 0.3% Cream ST | Policy |
| Topical Products - Zoryve Foam ST | Policy |
| Topical Retinoids - Aklief PA Policy | Policy |
| Topical Retinoids - Panretin PA Policy | Policy |
| Topical Retinoids - Tazarotene Products PA Policy | Policy |
| Topical Vitamin D Analogs Step Therapy Policy | Policy |
| Vecamyl PA Policy | Policy |
| Veregen PA Policy | Policy |
| Vesicular Monoamine Transporter Type 2 Inhibitors - Austedo PA Policy | Policy |
| Vesicular Monoamine Transporter Type 2 Inhibitors - Ingrezza PA Policy | Policy |
| Vesicular Monoamine Transporter Type 2 Inhibitors - Tetrabenazine PA Policy | Policy |
| Vesicular Monoamine Transporter Type 2 Inhibitors PSM Policy | Policy |
| Vijoice PA | Policy |
| Vitamin B12 (Cyanocobalamin) Products Step Therapy Policy | Policy |
| Vitamin D Analog (Oral) Step Therapy Policy | Policy |
| Wakefulness-Promoting Agents - Armodafinil, Modafinil PA with Step Therapy Policy | Policy |
| Wakefulness-Promoting Agents - Sunosi PA Policy with Step Therapy | Policy |
| Wakefulness-Promoting Agents - Wakix PA Policy with Step Therapy | Policy |
| Weight Loss - Glucagon-Like Peptide - 1 Agonists PA Policy | Policy |
| Weight Loss - Glucagon-Like Peptide-1 Agonists PA | Policy |
| Weight Loss - Other Appetite Suppressants and Orlistat PA | Policy |
| Zokinvy PA Policy | Policy |