Drugs Requiring Prior Approval

Some prescription drugs may require certification, also known as prior authorization, in order to be covered. These drugs have detailed criteria that must be met before prior authorization can be granted.

If the drug you are looking for is not listed in the chart below, please check Drugs Requiring Step Therapy and Drugs Subject to Quantity Limits. Below is a chart of the drugs and drug classes that require prior authorization, the prior authorization policies and the methods for initiating a coverage review.

Drugs Requiring Prior Authorization	Drugs Requiring Prior Authorization	To Initiate a Coverage Review
Alpha Interferons	Alpha Interferons	Visit www.medco.com/coverage or call 1-800-753-2851
Antifungal Agents	Lamisil, Sporanox & Terbinex Noxafil Vfend	Visit www.medco.com/coverage or call 1-800-753-2851
Antinarcoleptic Agents	Nuvigil and Provigil	Visit www.medco.com/coverage or call 1-800-753-2851

Drugs Requiring Prior Authorization	Prior Authorization Policies	To Initiate a Coverage Review
COX2 Inhibitors	Celebrex	Visit www.medco.com/coverage or call 1-800-753-2851
Fentanyl	Fentanyl	Visit www.medco.com/coverage or call 1-800-753-2851
Fertility Agents	Fertility Agents	Visit www.medco.com/coverage or call 1-800-753-2851
Growth Stimulating Drugs	Growth Stimulating Drugs	Visit www.medco.com/coverage or call 1-800-753-2851
Immunomodulators	Revlimid Thalomid	Visit www.medco.com/coverage or call 1-800-753-2851
Multiple Sclerosis Agents	Ampyra Multiple Sclerosis Agents	Visit www.medco.com/coverage or call 1-800-753-2851
Omalizumab	Xolair*	Visit www.medco.com/coverage or call 1-800-753-2851
Psoriasis Treatment Agents	Psoriasis Treatment Agents*	Visit www.medco.com/coverage or call 1-800-753-2851

Drugs Requiring Prior Authorization	Prior Authorization Policies	To Initiate a Coverage Review
Rheumatoid Arthritis Agents	Tocilizumab (Actemra) Leflunomide (Arava) Certolizumab pegol(Cimzia) Etanercept (Enbrel) Adalimumab (Humira) Anakinra (Kineret) Abatacept (Orencia)* Infliximab (Remicade) * Rituximab (Rituxan)* Golimumab (Simponi)	Visit www.medco.com/coverage or call 1-800-753-2851
Sildenafil and Tadalafil	Revatio and Adcirca	Visit www.medco.com/coverage or call 1-800-753-2851

Provider Instructions

To initiate and/or complete prior authorizations (coverage reviews) with Medco, prescribers have several options available. First, prescribers with a Personal Identification Number (PIN) and password can log on to Medco's prescriber coverage review website (www.medco.com/coverage) to view existing coverage review cases for their patients, initiate a coverage review case for their patients (a rejected pharmacy claim must be on file in order to initiate a case), or complete a coverage review case (answer the coverage criteria questions required to determine coverage).

If a prescriber does not have, or does not know their PIN and password, please call Medco at 1-800-496-5661, 8:00am to 9:00pm, eastern time, Monday thru Friday, and a PIN and password will be provided.

Another option to initiate and/or complete a coverage review case is to contact Medco's coverage review department at 1-800-753-2851, twenty-four hours a day, seven days a week.

*These drugs may be covered under the pharmacy or medical benefit. If it is covered under the pharmacy benefit, contact Medco for prior approval. If it is covered under the medical benefit, contact Blue Cross and Blue Shield of North Carolina for approval.