Prescription Benefit Preauthorization Requirements
Which prescription medications require preauthorization?
- Cialis, Levitra, sildenafil, Viagra (excluded for erectile dysfunction)
- Cystic Fibrosis
- Finasteride, Proscar (excluded for hair loss)
- Hepatitis C
- Inflammatory Conditions
- Multiple Sclerosis
- Opioids in excess of seven days
- Substance abuse
- Medications listed as not covered on the plan's formulary
- Any medication exceeding $2,500 in cost
- Any compound medication exceeding $200 in cost
How do I initiate a preauthorization?
To initiate a preauthorization for a prescription, the prescriber must request the preauthorization using one of the following methods:
- Call EMI Health at 800-662-5851.
- Fax medical records to EMI Health, attention Pharmacy Review, at 801-269-9734.
- Use an online prior-authorization vendor such as Cover My Meds.
Preauthorization is not a guarantee of payment. Payment for preauthorized prescriptions is contingent upon eligibility and benefits at the time of service. All terms and provisions of the plan will apply, and any prescriptions in connection with a preauthorization approval that are exclusions or limited benefits will be reimbursed accordingly. Prescriptions that are exclusions of the policy will be denied; prescriptions that have plan limitations will be paid according to those limitations.
For more information, or if you have questions, contact customer service at 800-662-5851.
View medical benefit preauthorization requirements here.