Prior Authorization (PA):

Our Medicare Advantage plans require you to get prior authorization for certain drugs. This means that you will need to get approval from your Medicare Advantage plan before you fill your prescriptions. If you don't get approval, your Medicare Advantage plan may not cover the drug. Please click the Prior Authorization (PA) link to the left to access the PA criteria for your drug.

Quantity Limits (QL):

For certain drugs, our Medicare Advantage plans limit the amount of the drug that the plans will cover.

Step Therapy (ST):

In some cases, our Medicare Advantage plans require you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, our Medicare Advantage plans may not cover Drug B unless you try Drug A first. If Drug A does not work for you, our Medicare Advantage plans will then cover Drug B. Please click the Step Therapy (ST) link to the left to access the ST criteria for your drug.

Home Infusion Therapy (HI):

These prescription drugs may be covered under our medical benefit.

Limited Pharmacy Availability (LA):

These prescriptions may be available only at certain pharmacies.

Mail Order (MO):

These prescription drugs are available through mail-order.

Medicare Part B or D Prior Authorization (B/D PA):

These prescription drugs may be covered under Medicare Part B or D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination.

Non-Extended Day Supply (NEDS):

In an effort to control drug costs, certain high-cost drugs will be limited up to a 30-day supply per fill.