If my medication is considered preventive on the formulary, do step therapy and/or prior authorization requirements still apply?
Yes. Providence Health Plan prior authorizes drugs for a variety of reasons that are independent of the preventive status of a drug. These reasons include review for medical necessity, place of therapy, length of therapy, step therapy or number of doses. Providence Health Plan considers many factors before requiring prior authorization or step therapy on a prescription drug including: serious risks, FDA approved indications, cost-effectiveness and new medications on the market that have not been widely used or evaluated. Preventive drugs that may require prior authorization (PA), step therapy (ST) or quantity limit (QL) are identified as such in the comments column in the formulary. If your preventive medication requires prior authorization, contact your doctor or other medical provider to submit an authorization request.
