HealthChoice Medicare Supplement Plans
Medications Requiring Prior Authorization

Prior authorization is always needed for certain drugs even though they are listed in the HealthChoice Medicare Formulary.  Prior authorization is required if the drug:

• Has a very high cost
• Has specific prescribing guidelines
• Might be covered under Medicare Part B
• Is generally used for cosmetic purposes

A request for prior authorization must be submitted by your physician.  Your request must be approved before you fill your prescription.  To apply:

1. Have your physician’s office contact Medco toll-free at 1-800-753-2851. Your physician’s office will need to have your member ID and medication name available.
2. Medco will fax a Prior Authorization Form to your physician’s office and request that it be completed and faxed back.
3. If your prior authorization is approved, your physician’s office will receive notice of the approval within 24 to 48 hours.  You will also be notified in writing.
4. If your prior authorization is denied because it does not meet clinical criteria, your physician’s office will receive notice of denial within 24 to 48 hours.  You will also be notified in writing.

Note:  A prior authorization is valid for one year from the date it is issued and must be renewed when it expires. 

Use the links below to go to the different medication categories and then find your medication in the list. To read the reasons your medication requires prior authorization, simply click on the medication name. Please note this list is not all inclusive and is subject to change.

ADRENAL HORMONES
ANTI-HYPERTENSIVE THERAPIES
ANTI - INFECTIVES
ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS
CARDIOVASCULAR, HYPERTENSION / LIPIDS
ERECTILE DYSFUNCTION
GASTROENTEROLOGY
IMMUNOLOGY, VACCINES / BIOTECHNOLOGY
MISCELLANEOUS AGENTS
MISCELLANEOUS HORMONES
MISCELLANEOUS NEUROLOGICAL THERAPIES
NON-NARCOTIC ANALGESICS
OSTEOPOROSIS THERAPY
PSYCHOTHERAPEUTIC DRUGS
PULMONARY AGENTS
RHEUMATOLOGICALS

ADRENAL HORMONES 

a-methapred - injection solution reconstituted
DEPO-MEDROL - injection suspension
methylprednisolone - oral tablet
methylprednisolone acetate - injection suspension
methylprednisolone sodiumsuccinate - injection solution reconstituted
prednisolone sodium phosphate - oral solution
prednisone - oral solution, oral tablet
PREDNISONE INTENSOL - oral concentrate
SOLU-MEDROL - injection solution reconstituted

ANTI-HYPERTENSIVE THERAPIES 

REMODULIN - injection solution

ANTI - INFECTIVES 

amphotericin b - injection solution reconstituted
CUBICIN - injection solution reconstituted
foscarnet sodium - injection solution
NEBUPENT - inhalation solution reconstituted
TOBI - inhalation nebulization solution
vancomycin hcl - injection solution

ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS 

AFINITOR - oral tablet
azathioprine - oral tablet
azathioprine sodium - injection solution reconstituted
CELLCEPT - oral capsule, oral suspension reconstituted, oral tablet
cyclophosphamide - oral tablet
cyclosporine - oral capsule, injection solution
cyclosporine modified - oral capsule, oral solution
gengraf - oral capsule, oral solution
methotrexate - oral tablet
mycophenolate mofetil - oral capsule, oral tablet
MYFORTIC - oral tablet delayed release
NEORAL - oral capsule, oral solution
NEXAVAR - oral tablet
PROGRAF - oral capsule, injection solution
RAPAMUNE - oral solution, oral tablet
RHEUMATREX - oral tablet
RITUXAN - concentrate
SANDIMMUNE - oral capsule, injection solution, oral solution
SUTENT - oral capsule
tacrolimus - oral capsule
TARCEVA - oral tablet
THALIDOMIDE - oral capsule
TORISEL - injection solution
ZORTRESS - oral tablet

CARDIOVASCULAR, HYPERTENSION / LIPIDS 

nitroglycerin - injection solution

ERECTILE DYSFUNCTION 

CAVERJECT - injection solution
CIALIS - oral tablet
LEVITRA - oral tablet
MUSE - oral tablet
VIAGRA - oral tablet

GASTROENTEROLOGY 

CIMZIA - kit
dronabinol - oral capsule
EMEND - oral capsule
granisetron - oral tablet
ondansetron hcl - oral solution, oral tablet
ondansetron odt - oral tablet dispersible
REMICADE - injection solution
ZUPLENZ - film

IMMUNOLOGY, VACCINES / BIOTECHNOLOGY 

ARANESP - injection solution
AVONEX - kit
BETASERON - injection solution reconstituted
ENGERIX-B - injection suspension
EPOGEN - injection solution
HIZENTRA - injection solution
LEUKINE - injection solution reconstituted
NEULASTA - injection solution
NEUMEGA - injection solution reconstituted
NEUPOGEN - injection solution
NORDITROPIN FLEXPRO - injection solution
NORDITROPIN NORDIFLEX PEN - injection solution
OMNITROPE - injection solution
PRIVIGEN - injection solution
PROCRIT - injection solution
REBIF - injection solution
REBIF TITRATION PACK- injection solution
RECOMBIVAX HB - injection suspension
TEV-TROPIN - injection solution reconstituted
TWINRIX - injection suspension
VIVAGLOBIN - injection solution

MISCELLANEOUS AGENTS 

levocarnitine - solution, oral tablet

MISCELLANEOUS HORMONES 

ALDURAZYME - injection solution
ANADROL-50 - oral tablet
ANDRODERM - oral tablet
ANDROGEL - topical gel
ANDROID - oral capsule
androxy - oral tablet
calcitriol - oral capsules, solution
CEREZYME - injection solution reconstituted
FABRAZYME - injection solution reconstituted
SOMAVERT - injection solution reconstituted
testosterone cypionate - oil
testosterone enanthate - oil
ZEMPLAR - oral capsule, injection solution

MISCELLANEOUS NEUROLOGICAL THERAPIES 

COPAXONE - kit
GILENYA - oral capsule

NON-NARCOTIC ANALGESICS 

CELEBREX - oral capsule

OSTEOPOROSIS THERAPY 

BONIVA - oral tablet

PSYCHOTHERAPEUTIC DRUGS 

dextroamphetamine sulfate - oral tablet
dextroamphetamine sulfate er - oral capsule
FOCALIN XR - oral capsule
METADATE CD - oral capsule
methylphenidate hcl- oral tablet
methylphenidate hcl sr - oral tablet
PROVIGIL - oral tablet
RITALIN LA - oral capsule

PULMONARY AGENTS 

acetylcysteine - inhalation solution
albuterol sulfate - inhalation nebulization solution
budesonide - inhalation solution
cromolyn sodium - inhalation nebulization solution
ipratropium bromide - inhalation solution
ipratropium bromide/albuterol sulfate - inhalation solution
PERFOROMIST - inhalation solution
PULMICORT - inhalation suspension
PULMOZYME - inhalation solution
XOLAIR - injection solution reconstituted

RHEUMATOLOGICALS 

ENBREL - injection solution
HUMIRA - kit
SIMPONI - injection solution