Please click below for the Prior Authorization Criteria document
For certain drugs, you or your provider need to get approval from the plan before we will agree to cover the drug for you. This is called "prior authorization". Sometimes the requirement for getting approval in advance helps guide appropriate use of certain drugs.
2016 Prior Authorization Criteria
2017 Prior Authorization Criteria
PLEASE NOTE: Our drug list is updated monthly. For the most current list of drugs on the formulary, please refer to the "CareMore Health Plans Online Formulary Search" tool under Drug Formulary and Pharmacy Search. Copayment amounts can be found on your Plan Benefit Chart (PDF) under Plan Materials in Member Materials. If you have any additional questions regarding the formulary or copayments, please call Member Services at 1-800-499-2793 (TTY users should call: 711). Representatives are available 8 a.m. - 8 p.m., 7 days a week (October 1 - February 14) and Monday - Friday (February 15 -September 30).
In most cases, your prescriptions are covered only if they are filled at the plan's network pharmacies. Use the below Pharmacy Search tool to find a network pharmacy in your area.