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 criteria can be found on the Medical Benefit Drug List (MBDL).
Additional Coverage
Check your plan documents to see whether the below rider is included in your plan.
IRS-allowed Chronic Condition Services, Supplies and Prescription Drug rider
Medical Drug criteria can be found on the Medical Benefit Drug List (MBDL).