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Provider Manual

Prior Authorization

Last Updated on August 28, 2018

Family Health Center may designate that coverage is available for specific drugs on a prior authorization basis only. Drugs that require prior authorization are generally high-cost specialty drugs (such as TNF inhibitors) or those that have a more cost effective and clinically appropriate first-line drug option. For a complete list of drugs that require prior authorization, click here. To request a prior authorization, refer to the Pharmacy Authorization Requests section.

A team of physicians and pharmacists internally develop prior authorization criteria, which are supported by evidence-based practices. Prior authorization criteria are available online. Printed copies of the policies and procedures are available upon request.