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 |
Visit www.medco.com/coverage or call 1-800-753-2851 |
|
Antifungal Agents |
Visit www.medco.com/coverage or call 1-800-753-2851 |
|
Antinarcoleptic Agents |
Visit www.medco.com/coverage or call 1-800-753-2851 |
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Drugs Requiring Prior Authorization |
Prior Authorization Policies |
To Initiate a Coverage Review |
|---|---|---|
COX2 Inhibitors |
Visit www.medco.com/coverage or call 1-800-753-2851 |
|
Fentanyl |
Visit www.medco.com/coverage or call 1-800-753-2851 |
|
Fertility Agents |
Visit www.medco.com/coverage or call 1-800-753-2851 |
|
Growth Stimulating Drugs |
Visit www.medco.com/coverage or call 1-800-753-2851 |
|
Immunomodulators |
Visit www.medco.com/coverage or call 1-800-753-2851 |
|
Multiple Sclerosis Agents |
Visit www.medco.com/coverage or call 1-800-753-2851 |
|
Omalizumab |
Visit www.medco.com/coverage or call 1-800-753-2851 |
|
Psoriasis Treatment Agents |
Visit www.medco.com/coverage or call 1-800-753-2851 |
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Drugs Requiring Prior Authorization |
Prior Authorization Policies |
To Initiate a Coverage Review |
|---|---|---|
Rheumatoid Arthritis Agents |
Visit www.medco.com/coverage or call 1-800-753-2851 |
|
Sildenafil and Tadalafil |
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.

