Rx Prior Authorization

Drugs that Require Prior Authorization

Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. This approval process is called prior authorization.

Drug list/Formulary inclusion does not infer a drug is a covered benefit. Please check your schedule of benefits for coverage information.

Attention Medicare Members: The information on this page does not apply to members on Anthem’s Group Medicare Prescription plan with Senior Rx Plus. Please see the Group Medicare Drug Lists page or call Customer Service at the number on the back of your membership card for information on requirements which apply to the Group Medicare Prescription plans.

Attention Prescribing Providers with members who are enrolled in an Anthem California plan: The Prescription Drug Prior Authorization Or Step Therapy Exception Request Form must be used for all members enrolled in a California plan, regardless of residence. We will be unable to review your request for authorization if it is not submitted on the Prescription Drug Prior Authorization Or Step Therapy Exception Request Form. The drug specific criteria and forms found within the (Searchable) lists on the Drug List Search tab are for informational purposes only to assist you in completing the Prescription Drug Prior Authorization Or Step Therapy Exception Request Form if they are helpful to you. Please fill out the Prescription Drug Prior Authorization Or Step Therapy Exception Request Form and fax it to (844) 474-3347.

Select the Drug List Search tab to access up-to-date coverage information in your drug list, including – details about brands and generics, dosage/strength options, and information about prior authorization of your drug.