Non-Preferred Drugs

Requests for non-preferred drugs are subject to prior notification and will be evaluated for the following circumstances:

• Patient has documented treatment failure with the preferred drugs.
• Preferred drugs are contraindicated for treatment.
• Patient experienced an allergic reaction to the preferred drugs.
• The requested non-preferred drug is documented to be safe and effective for treatment of the condition for which it is requested.

Contact our pharmacy call center at 1-800-310-6826 to request approval of a non-preferred medication