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Glossary
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WHAT IS COVERED

When to Get Prior Approval for a Prescription

Certain prescription drugs must be approved for coverage before you fill a prescription. These drugs include but are not limited to:

  • Alglucerase (treatment for liver, spleen and bone marrow conditions);
  • Erythropoetin (used to treat anemia associated with HIV or its treatments);
  • Filgrastim (helps the body make white blood cells to prevent infections);
  • GM-CSF (used to treat non-Hodgkin’s lymphomas and leukemia);
  • Growth hormones;
  • Octreotide (used on growth hormones, certain tumors and gastrointestinal problems);
  • Cialis (or other sexual dysfunction agent) when prescribed to treat Benign Prostatic Hyperplasia (BPH) after traditional treatments have provided unsatisfactory results;
  • All compound drugs costing more than $300 for a 30-day supply (adjusted pro-rata for the quantity); and
  • All prescription drugs and Specialty Drugs costing more than $1,000 per supply day.

To get approval for any of the above prescription drugs, your doctor or provider should call CVS Caremark at the toll-free number shown on the chart here.

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