Drugs Requiring PA
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. It is very important to make sure that prior authorization has been granted before going to the pharmacy. Please review the State Health Plan's prior authorization policies. Below is a list of the drugs and drug classes that require prior authorization:
If you disagree with a decision made during the prescription drug prior authorization process, you have the right to request that the State Health Plan or its representative review the decision through the grievance process. The grievance process is voluntary and may be requested by the member or an authorized representative acting on the member's behalf. Visit the PPO plan grievance page.
- Alpha Interferons
- Antifungal Agents
- Lamisil and Sporanox
- Noxafil
- Vfend
- Antinarcoleptic Agents (Provigil)
- Appetite Suppressants and Weight Loss Agents
- Bisphosphonates
- Actonel
- Actonel with Calcium
- Certolizumab (Cimzia)
- Clostridium Botulinum Neurotoxins (Botox, Myobloc)
- COX2 Inhibitors (Celebrex)
- Fentanyl (Actiq and Fentora)
- Fertility Agents
- Growth Stimulating Drugs
- Immunomodulators
- Revlimid
- Thalomid
- Multiple Sclerosis Agents
- Non-Sedating Antihistamines
- Omalizumab (Xolair)
- Proton Pump Inhibitors
- Aciphex
- Prevacid
- Protonix
- Psoriasis Agents
- Rheumatoid Arthritis Agents
- Leflunomide (Arava)
- Etanercept (Enbrel)
- Adalimumab (Humira)
- Anakinra (Kineret)
- Infliximab (Remicade)
- Abatacept (Orencia)
- Rituximab (Rituxan)
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Lexapro
- Luvox CR
- Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
- Effexor XR
- Pristiq
- Sildenafil (Revatio)
- Migraine Medications
- Imitrex
- Zomig/ZMT
- Amerge
- Maxalt/MLT
- Axert
- Frova
- Relpax
- Migranal NS)
- Treximet
- Proton Pump Inhibitors
- Prilosec
- Aciphex
- Nexium
- Prevacid
- Protonix
- Sedative Hypnotic Agents
- Rozerem
- Sonata
- Ambien
- Ambien CR
- Lunesta
If you disagree with a decision made during the prescription drug prior authorization process, you have the right to request that the State Health Plan or its representative review the decision through the grievance process. The grievance process is voluntary and may be requested by the member or an authorized representative acting on the member's behalf. Visit the PPO plan grievance page.

