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What is the criteria for determining coverage for those drugs that require precertification or step-therapy?

April 26, 2017coverage criteria determining drugs Precertification require step-therapy

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What is the criteria for determining coverage for those drugs that require precertification or step-therapy?

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Pharmacy Clinical Policy Bulletins are used for those members with benefit plans covering selected outpatient prescription drugs on the Formulary Exclusions List or those drugs that require precertification or step-therapy. For detailed information, including specific criteria, see our Pharmacy Clinical Policy Bulletins.