Information Regarding Prescription Drug Preauthorization

Prescription Drug Preauthorization

Helping keep costs down and getting the most appropriate treatment.

The WEA Trust requires preauthorization for certain prescription drugs.The sections below detail which drugs are handled by which company.

Questions About Drug Preauthorization?

WEA Trust Customer Service for Members: 800-279-4000
WEA Trust Customer Service for Providers: 800-279-4090
MedImpact: 888-807-8106

 

Q:Managed By MedImpact

For a list of the most Common Drugs Requiring Preauthorization, please reference our Preferred Drug List.

For a complete list, please reference our Complete Formulary.


Most common prescription drugs requiring preauthorization:

  • Adapalene (over age 25)
  • Androgel
  • Aripiprazole
  • Copaxone
  • Crestor
  • Dextroamphetamine-amphetamine (quantity limit)
  • Dextroamphetamine-amphetamine ER (over age 18)
  • Elidel
  • Enbrel
  • Enoxaparin Sodium
  • Fentanyl
  • Gleevac
  • Harvoni
  • Humira
  • Imiquimod
  • Jublia
  • Latuda
  • Methylphenidate ER (over age 18)
  • Modafinil
  • Neulasta
  • Nexium
  • Nuvaring
  • Nuvigil
  • Pristiq ER
  • Sovaldi
  • Subuxone
  • Tecfidera
  • Tretinoin (over age 25)
  • Vancomycin
  • Vesicare
  • Vyvanse
  • Xyrem
  • Zolpidem tartrate ER

Q:Managed By WEA Trust

Preferred Biosimilars

Click here for the preferred Biosimilars chart

Prescription Drugs Requiring Preauthorization

Please use our Medication Preauthorization Form for the following medications:

Alpha-1 Proteinase Inhibitors
  • Aralast-NP
  • Glassia
  • Prolastin-C
  • Zemaira
Antiarrhythmic
  • Antiarrhythmic Drug BetaPace Induction
Antihemophilic Factors
  • Alprolix
  • Antihemophilic Factor VIII
  • Emicizumab-KXWH
  • Esperoct
  • Hemlibra
  • Hyaluronan
Antirheumatic
  • Euflexxa
Asthma Biologic Treatments
  • Fasenra
  • Nucala
  • Xolair
Botulinum Toxin Treatments
  • Botox
  • Dysport (preferred)
  • Myobloc
  • Xeomin
C1 Esterase Inhibitor
  • Berinert
  • Cinryze
  • Haegarda
  • Ruconest
Colony-Stimulating Factors
  • Epoetin (Epogen/Procrit)
  • Filgrastim
  • Granix
  • Nivestym
  • Pegfilgrastim - Ziextenzo
Enzyme Replacement Therapy
  • Adagen
  • Aldurazyme
  • Brineura
  • Cerezyme
  • Cerliponase Alfa
  • Elaprase
  • Elelyso
  • Fabrazyme
  • Kanuma
  • Lumizyme
  • Mepsevii
  • Myozyme (aglucosiderase)
  • Naglazyme
  • Revcovi
  • Vimizim
  • Vpriv
Hyaluronate Derivative
  • Triluron (hyaluronate derivative)
  • Visco-3 (hyaluronate derivative)
Immune Globulins
  • Bivigam
  • Carimune NF
  • Cinqair
  • Cuvitru
  • Flebogamma
  • GamaSTAN
  • Gammagard
  • Gammaplex
  • Gamunex
  • Hizentra (SC only)
  • HyQvia (SC only)
  • Octagam
  • Privigen
  • Xembify
  • Zinplava – effective 1/1/2020
Inflammatory Biologics
Interferons/Biologic Response Modifier
  • Interferon and Peginterferon for Hepatitis B
  • Pegylated Interferon Alfa
Kallikrein Inhibitor
  • Kalbitor
  • Takhzyro - effective 1/1/2020
Multiple Sclerosis
  • Lemtrada
  • Ocrevus
Ophthalmic Agent
  • Eylea
  • Lucentis
Prostaglandin
  • Flolan – effective 1/1/2020
  • Remodulin
  • Veletri
siRNA Agent
  • Givlaari (givosiran)
  • Onpattro – effective 1/1/2020
  • Patisiran
Others
  • Aranesp
  • Aripiprazole lauroxil
  • Beuprenorphine Implant
  • Cimzia
  • Crizanlizumab - effective 4/1/2020
  • Crysvita
  • Durolane (hyaluronate derivative)
  • Enfortumab vedotin-ejfv, 0.25 mg
  • Enhertu
  • Firazyr
  • Flolan
  • Fulphila
  • Gel-One (hyaluronate derivative)
  • Gelsyn-3 (hyaluronate derivative)
  • Gemcitabine hydrochloride, (Infugem), 100 mg
  • GenVisc 850 (hyaluronate derivative)
  • Hizentra SC
  • HP Acthar
  • Hyalgan (hyaluronate derivative)
  • Hydroxyprogesterone
  • Hymovis (hyaluronate derivative)
  • Kadcyla (trastuzumab)
  • Makena (hydroxyprogesterone)
  • Melphalan (Evomela), 1 mg
  • Mepsevii
  • Monovisc (hyaluronate derivative)
  • Neulasta
  • Neulasta OnPro
  • Neupogen
  • Nivestym
  • Nplate
  • Ontruzant (trastuzumab)
  • Orthovisc (hyaluronate derivative)
  • Padcev
  • Paricalcitol
  • Parsabiv - effective1/1/2020
  • Prolia
  • Remicade
  • Retacrit
  • Ruxience (rituximab)
  • Signifor LAR
  • Somatuline Depot
  • Supartz (hyaluronate derivative)
  • Supprelin LA
  • Synagis
  • Synojoynt
  • Synvisc (hyaluronate derivative)
  • Synvisc-One (hyaluronate derivative)
  • Tepezza (teprotumumab)
  • Trastuzumab deruxtecan-nxki, 1 mg
  • Trazimera (trastuzumab)
  • Trogarzo - effective 1/1/2020
  • Udenyca - effective 5/15/2020
  • Ultomiris
  • Xgeva
  • Xiaflex
  • Zaraxio

Additional Prescription Drug Policies


Customer Service

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