2023 Approved Drug List
Electronic prior authorization
Downloads
Some drugs may require your provider to fill out an authorization form.- Commercial/Individual prior authorization criteria
- Pharmacy drug request
- Oral oncology drug request
- Opioid quantity limit exception request
Drugs covered under the medical benefit
- Medical Benefit Drug List (MBDL) (formerly the Injectable drug list)
- Medical drug request
- Oncology medical drug request
Medical drug-specific forms are linked in the Medical Benefit Drug List
Additional Coverage
If you have an HSA plan, you may receive additional coverage through your employer for certain medications. This coverage is called a plan rider. Check your plan documents to see whether one of the below riders is included in your plan.