Health Benefits

Prescription Drug Prior Authorization Program*

There are a number of prescription drugs which now require prior authorization before they can be determined eligible under the Plan*. The Prior Authorization Listing of these drugs can be found online at:

If your doctor prescribes a drug for you or one of your Eligible Dependents, that is on the Prior Authorization Listing, when you take your prescription to the pharmacy, your Pharmacist will be advised that you must obtain prior authorization first. You will then need to download the applicable Prior Authorization (PA) form for that drug from:  and complete the patient section, have the prescribing Physician complete their section of the form, and then send the completed form to where indicated. This information will be reviewed, and it will be determined whether the required eligibility criteria is met.  The decision will be communicated directly with the patient or individual indicated by the patient on the form. If deemed to be eligible, an exception will be added to that patient’s Plan record so that the pay-direct card will accept that drug going forward according to the terms of the approval.

NOTE: do not purchase your medication in advance of the completion of the Prior Authorization Process. Claims are not covered retroactively. Please wait to confirm criteria has been met before returning to your pharmacy to fill your prescription.

It's recommended that you refer to the Prior Authorization Listing while you are with your doctor, so that if a drug they intend to prescribe is on the Listing, the applicable Prior Authorization form can be downloaded, printed, and completed before you leave your doctor’s office.

If you need assistance accessing a Prior Authorization form, you can contact the claims customer service department at D.A. Townley.

*Does not apply to Retiree Benefits

Back to top