Prescription Drug Preauthorization

Find out which prescriptions need preauthorization.

Self-administered medications

Self-administered OR provider-administered specialty medications

Provider-administered specialty medications

The WEA Trust requires your doctor to call 800.279.4000 for approval before we pay for any provider-administered (including hospital, doctor's office, and infusion sites) specialty medications such as those listed below. Please keep in mind that the list below is not complete but contains examples of common provider-administered specialty drugs.

Dispense as written

Generic drugs save you and your health plan money. The Food and Drug Administration's clinical evidence shows that generic equivalents work just as well as brand-name drugs for patients in nearly all cases. A prescription written as "dispense as written" (DAW) means a pharmacist cannot substitute a generic equivalent for the brand-name drug. Your Trust health plan requires your physician to justify the medical need for a DAW brand-name prescription over its generic equivalent.

Download the [Dispense As Written Preauthorization Form] for you and your doctor to complete. We would also like your doctor to complete the optional MedWatch Form, which helps the FDA track occurrences where a medication's quality and effectiveness might be in doubt.

Step therapy

Step therapy means you have to first try one drug to treat a condition before another drug to treat that condition is covered. Step therapy promotes safe and cost-effective drug utilization based on clinical protocols agreed to by medical experts, the makers of the drugs, and the Food and Drug Administration (FDA).

Members with a new prescription for a drug listed below must try a first-line treatment or have their doctor call 800.294.5979 or 800.279.4000 for approval before receiving coverage. (If you're in the Three-Tier Drug Plan, remember that copayments vary even for drugs that may be approved.):

Dispensing limits

For certain drugs, we will reimburse to the quantity limit considered safe and effective by the FDA and the drug manufacturer for a 30-day supply. The following drugs may require preauthorization depending on the quantity dispensed:

If your doctor believes the quantity limits do not meet your needs, we ask that he or she call 800.294.5979.

If you have a question on whether or not a certain drug requires preauthorization, please contact us to ensure you'll be reimbursed.