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Office/medical setting administered medications that require prior authorization

Last Updated on February 19, 2026

Security Health Plan of Wisconsin, Inc., collaborates with Prime Therapeutics Management to manage prior authorization (PA) and/or post-service claim edits (PSCE) for select specialty pharmacy medications. 

To learn more about the Security Health Plan Medical Pharmacy Program with Prime Therapeutics Management see frequently asked questions.

Prior authorization list

Please note: If a drug is denied due to the review processes outlined below any administration fee associated to that drug will also be denied.

Identifying which specialty medications require PA and/or PSCE

The Medical pharmacy authorization and home infusion webpage lists the most recent medications requiring PA and/or PSCE.

To view the full list of medications requiring PA through Prime Therapeutics Management:

  1. Go to Select Category
  2. Choose "Prime Therapeutics Management Prior Authorizations" from the drop-down menu
  3. Click Search

To view the full list of medications requiring PA through Security Health Plan:

  1. Go to Select Category
  2. Choose "Security Health Plan Prior Authorizations" from the drop-down menu
  3. Click Search

To search for a specific medication:

  1. Type the drug code or generic/brand name directly into the Search field
  2. Click search

Oncology treatment (chemotherapy and radiation) prior authorizations

Security Health Plan partners with eviti to manage authorizations for oncology treatment (chemotherapy and radiation).

  • Authorization requests must be submitted by the provider through eviti. Connect at eviti.com.
  • eviti Oncology Authorization FAQ (Coming Soon)
  • More information, including pre-recorded trainings, FAQs and more: Eviti Provider Resources

Medications requiring prior authorization through Prime Therapeutics Management

  • Medication instructions will include "Prior authorization is required" and contact information will indicate: "To prior authorize, submit to Prime Therapeutics Management."
  • All Prime Therapeutics Management medications requiring prior authorization will also be subject to PSCE. Medication instructions will indicate "Post service claim edits are applied." (See the Post service claim edit below for additional details).

If you would like to submit an PA to Prime Therapeutics Management now, click the button. Note: You may be asked to sign in or click a link to fill out a new provider access request.

Submit PA to Prime Therapeutics

Medications requiring prior authorization through Security Health Plan

  • Medication instructions will include "Prior authorization is required" and direct you to log into Security Health Plan’s provider portal or fax the completed Prior Authorization Request form to Security Health Plan.

Post service claim edits

All Prime Therapeutics Management medications requiring prior authorization are also passed through Post service claim edits (PSCE). Some select drugs will not require prior authorization. Medication instructions for specialty medications subject to PSCE will indicate "Post service claim edits are applied" and not include "Prior authorization is required."

These medications will be subject to only PSCE—through Prime Therapeutics Management or Security Health Plan. The Categories section at the bottom of the instructions indicates whether PSCE is performed by Prime Therapeutics Management or Security Health Plan.

How does Security Health Plan decide which medical drugs require utilization management?

Security Health Plan’s Policy and Procedure committee determines or reviews criteria to promote safe and effective use of drugs.

Policies are determined based on established clinical practice guidelines, clinical evidence, cost-effectiveness and the availability of alternatives to ensure safe, effective and proper use of drugs and health care dollars. Clinical evidence may include peer-reviewed medical literature, accepted national treatment guidelines and opinions of clinical experts in various medical specialties.

How does a member or provider request an exception for medical drug Step Therapy?

The process begins with communication between the prescriber, the member or the person appointed to manage the member’s care and Health Plan staff.

The request must provide the following:

  1. Member name and date of birth
  2. Prescriber name, address and telephone number
  3. Drug name, strength, dosage form and directions
  4. Completed Step Therapy Override Determination Form 
  • Information provided must be sufficient to assess whether the request meets criteria for approval.
  • If the prescriber provides an oral supporting statement, the Health Plan may require the prescriber to subsequently provide a written supporting statement.
  • The prescriber may also be required to provide additional supporting medical documentation as part of the written follow-up.

The request and supporting documentation may be delivered via one of the following methods:

  • Fax: 1-715-221-6616
  • Phone: Security Health Plan Health Services: 1-800-991-8109
  • Mail:Security Health Plan
    Health Services Department
    PO Box 8000
    Marshfield, WI 54449-8000
  • For a “Standard” request, decision shall be granted or denied within 3 business days of receipt of the completed Step Therapy Override Determination form.
  • For an Urgent or “fast” request, an approval or denial will be granted by the end of the next business day after receipt of the complete Step Therapy Override Determination form

How does a member or provider appeal a denial for Step Therapy exception?

If we deny your request, you can appeal our decision. A written appeal request should be sent to:

Security Health Plan
Attn: Quality
PO Box 8000
Marshfield, WI 54449-8000
Fax 715-221-9500

  • When we give you our decision, we will use the “standard” deadlines unless we have agreed to use the “fast” deadlines. A standard appeal means we will give you an answer within 30 days of receiving your request.
  • Remember, if your health requires it, ask us to give you a “fast appeal.” A fast coverage decision means we will give you an answer within 72 hours of receiving your request.
  • To request a fast appeal, call 1-800-472-2363 or TTY: 711. We are open Monday through Friday, 7 a.m. to 5:00 p.m. If you are hearing or speech impaired, please call TTY: 711

Additional resources