Drug Management Programs

Your health plan may use programs such as these to manage coverage of prescription drugs. For information on which ones apply to you, log into the secure portion of this website to review your specific benefits.

Prior authorization

You may need prior approval for coverage of certain drugs. Learn how the Prior Authorization Program works.

Quantity management

There may be limits on the amount of certain drugs your plan will cover. Learn how the Quantity Management Program works and which drugs are included in the program.

Step therapy

This program encourages quality, cost-effective drug therapy. It groups drugs into two categories. Members must try one or more Step One Drugs before their plans will cover Step Two Drugs. Learn how the Step Therapy Program works and which drugs are included in the program.

Drug management programs for specialty drugs

Specialty drugs are prescription medications that treat complex or chronic medical conditions such as cancer, rheumatoid arthritis, multiple sclerosis and hepatitis. Depending on your plan, you may pay a different copayment or coinsurance for drugs on the Specialty Drug List.

Specialty drugs sometimes are covered by a health plan’s medical benefits, rather than prescription drug benefits. In these cases, different coverage rules may apply.

Prior authorization

Some medical (injectable/infusible) specialty drugs require prior authorization. Learn how the Medical Prior Authorization program works and which drugs it applies to.

Self-administered drugs

Pharmacy benefits cover certain self-administered specialty drugs. Learn how the Self-Administered Drug program works and which drugs it applies to.

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