Dean Health Plan medical management

Medical prior authorization service list

Medical injectables

Medical benefit prior authorization form

Medical oncology drugs (effective 1/1/23)

Medical non-oncology drugs (effective 10/01/2023)

Exception to coverage form (for new FDA approved drugs on the market for less than a year and have not been reviewed or granted approval through the Pharmacy & Therapeutics Committee.)

Non-covered services

Non-covered durable medical equipment & supplies