Medical Injectables

If your plan requires a prior authorization on medical injectables, please see the list below for those medications requiring prior authorization. If you are unsure if your plan requires prior authorization on medical injectables, please contact Customer Services as listed on your ID card or refer to your Summary Plan Description.

Drug Prior Authorization List

Select the group/plan and then click on the Drug to download the Preauthorization Form.

If you do not see your group/plan name listed, your plan does not require a Prior Authorization for Medical Injectables at this time.

NOTE: The Prior Authorization process for Botulinum Toxin medication follows our normal Medical Prior Authorization process. Please submit a prior authorization request via NaviNet or via the Outpatient Prior Authorization form.

Please have your prescribing physician request a prior authorize for any of the listed prescriptions.