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Provider Manual

Prior Authorization

Last Updated on August 28, 2018

Security Health Plan 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 TNFinhibitors) 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, please visit the formulary on the Prescription Tools page. To request a prior authorization, login to your Provider Portal and submit requests electronically or contact Pharmacy Services at 1-877-873-5611.

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.