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.
