Prescription drug preauthorization
The WEA Trust requires your doctor to call (800) 294-5979 for approval before we pay for the drugs listed below:
- Amevive
- Boniva injection
- Byetta
- Celebrex
- Clarinex
- Crinone
- Enbrel
- Femara
- Flector
- Growth hormones
- Humira
- Kineret
- Lamisil
- Lupron
- Lyrica
- Nuvigil
- Orencia
- Pristiq
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- Prochieve
- Progesterone in oil
- Provigil
- Prozac Weekly
- Raptiva
- Reclast
- Renexa
- Soriatane
- Sporanox (generic: itraconazole)
- Synagis
- Topical tretinoin (age 26 or older)
- Veramyst
- Xanax XR (generic: alprazolam ER)
- Xolair
- Xyzal
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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. (See the FDA's Web site on generic drugs.) 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 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.)
Angiotensin Receptor Blockers*
- Atacand
- Avalide
- Avapro
- Benicar
- Cozaar
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- Diovan
- Hyzaar
- Micardis
- Teveten
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*First-line treatment drugs are Capoten (captopril), Lotensin (benazepril), Vasotec (enalapril), or Zestril (lisinopril).
Quantity 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:
- Actiq
- Amerge
- Axert
- Fentoral
- Frova
- Imitrex
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- Maxalt
- Migranal NS
- Opana
- Relpax
- Zolpidem
- Zomig
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If your doctor believes the quantity limits do not meet your needs, he or she can call (800) 294-5979. |
Why do some drugs require preauthorization?
Drugs that require preauthorization are often inappropriately prescribed. Our goal with preauthorization is to help keep drug costs down and ensure that our members are getting the most appropriate drug for their needs.
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