What do members need to do if their prescriptions require a prior authorization or step therapy?
The physician should have a current list of drugs requiring prior authorization or step therapy. The drug rider to the policy that explains the drug benefit also lists these drugs. When members fill their prescriptions at a retail pharmacy, the pharmacist will be notified that the medication requires prior authorization and will take the necessary steps to request it. If members use home delivery, the physician must obtain prior authorization or follow the step therapy requirements before members can fill prescriptions.
