You will be notified in writing if the prescription is or is not eligible for coverage. Eligibility is not a guarantee of payment. The following is a list of medications currently requiring Prior Authorization. Some group contracts may include additional drugs or exclude some from this list. Ask your benefits administrator for more information.
Some groups contractually exclude coverage.
If your benefits provide coverage for these drugs, prior authorization is required. If your benefits do not include coverage for birth control, oral contraceptives are only covered when prescribed to treat a medical condition and require prior authorization. The following drugs have quantity limitations. Prior Authorization will be required if quantities greater than the plan limits are requested. This insert is not a contract or policy with Trigon Blue Cross Blue Shield.