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Prior Authorization

This list shows prescription medications that require your doctor to obtain authorization from us.

(s) indicates the pre-authorization is only required for Medex and Blue Care®65 members.

You can download the Physician Request for Prior Authorization form (also called the Formulary Exception form), which requires Adobe® Acrobat® Reader.

Medications that Require Prior Authorization

QUICK LINKS

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800-262-BLUE (2583)