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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. Depending on the drug, either MedImpact or Coram Specialty Infusion Services will handle preauthorization. The sections below detail which drugs are handled by which company.

Questions About Drug Preauthorization?

WEA Trust: 800-279-4000
Coram: 888-439-3661
MedImpact: 888-807-8106

Q:Managed By MedImpact

The list below contains the most common prescription drugs requiring preauthorization. For a complete list, please reference our Preferred Drug List.

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

Drug Name
Generic Name
Preauthorization Form
 ACTHAR HP   ACTHAR HP Preauthorization Form
Antihemophilic factors Factors VII/IX Factor IX Preauthorization Form
Botulinum Toxin Botox Botox Preauthorization Form
Entyvio   Entyvio Preauthorization Form
Epoetin Epogen/Procrit Epogen Preauthorization Form
Herceptin Trastuzumab
Interferon and Peginterferon for Hepatitis B
Interferon-Peginterferon Preauthorization Form
Lupron Lueprolide Lupron Preauthorization Form
Nucala Mepolizumab Nucala Preauthorization Form
Orencia Abatacept Orencia Preauthorization Form
Prolia Denosumab Prolia Preauthorization Form
Reclast/Zometa Zoledronic acid Reclast-Zometa Preauthorization Form
Remicade Infliximab Remicade Preauthorization Form
Rituxan Rituximab Rituxan Preauthorization Form
Simponi Aria Golimumab Simponi Aria Preauthorization Form
Soliris Eculizumab  Soliris Preauthorization Form
Stelara Ustekinumab Stelara Preauthorization Form
Tysabri Natalizumab Tysabri Preauthorization Form
Vivitrol Naltrexone Vivitrol Preauthorization Form
Xolair Omalizumab
Xolair Preauthorization Form
Yervoy Ipilimumab

Q:Managed By Coram

Drug Name
Generic Name
Code
Aldurazyme Laronidase J1931
Aralast
J0256
Bivigam
J1556
Carimune
J1566
Ceredase Alglucerase J0205
Cerezyme Imiglucerase J1786
Elaprase Idursulfase J1743
Fabrazyme Algalsidase J0180
Flebogamma
J1572
Gamastan S/D
J1460
Gammagard Liquid
J1569
Gammagard S/D
J1566
Gammaked
J1561
Gammaplex
J1557
Gamunex
J1561
Gamunex C
J1602
Glassia
J0256
Hizentra
J1559
Lumizyme Alglucosidase J0221
Myozyme Alglucosiderase J0220
Naglazyme Galsulfase
J1458
 Octagam    J1568
 Privigen   J1459 
 Vpriv  Valaglucerase J3385 
 Zemaira Alpha 1 Proteinase  J0256 

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