Of the7,444prior authorization requests we denied in 2023: 5,696were related to pharmacy benefits,1,656were related to medical benefits and92were related to behavioral health benefits 7,444were denied because the patient did not meet prior authorization criteria,0were denied due to incomplete info...
Our drug lists are meant to be guidelines for most members. To promote appropriate medicine utilization, we have processes and practices forprior authorization, step therapy, quantity limits and age limits. However: Providers and members may download and submit a formulary exception request form from...