Search our online formulary tool or drug- and plan-specific information on drug coverage, including prior authorization, step therapy requirements and quantity limits,
Drugs covered under the medical benefit
Reference the Medical Benefit Drug List (MBDL) (formerly the Injectable Drug List) to view coverage details for medications that are covered under the medical benefit. Forms for drugs that require authorization are linked in the MBDL.
Drugs covered under the pharmacy benefit
Coverage for medication and any applicable utilization management criteria can be found on the Approved Drug Lists. Since coverage and criteria differ by plan, choose the plan type to view the correct plan-approved drug list.
Approved Drug Lists
General drug request forms
Use these general forms when there is no drug-specific form listed.
Fax completed forms to Priority Health at 877.974.4411.
- Medicare Part D prior authorization criteria
- Medicare Part D coverage determination request form
- Medicare Part B prior authorization form
- Medicare Part B oncology prior authorization form
- Medicare Part B vs. Medicare Part D coverage determination form
- Hospice/Part D drug prior authorization form
- Medicare prescription drug request for redetermination (appeal) form