We want to make sure you get the safest, most effective medication available. That means your prescription may require a review before it is covered by your plan. During the review, your doctor can provide us with more detailed information about your prescription so we can make sure its use falls within your plan’s rules. These rules are based on the product information approved by the Food and Drug Administration (FDA) as well as published clinical trials and guidelines.
Your medication may also need a coverage review if it is a:
- Prescription used outside of the specific, approved medical conditions
- Prescription that could be used for non-medical purposes
To help avoid a coverage review, ask your doctor if they’re connected to Real-Time Prescription Benefit so they can check if your medication is covered by your plan before you try to fill it. You can also use your online account or our mobile app to check pricing and coverage.
You can check the status of a coverage review by logging in and going to Prior Authorizations under Prescriptions.