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Provider Manual

Prior Authorization

Last Updated on August 28, 2018

Certain prescription drugs require prior authorization (PA) from Security Health Plan before being covered under the Part D drug coverage. They appear on the formulary with the "PA" designation. Below is a list of drugs that require prior authorization with a brief description of the criteria used to make the coverage determination. In addition, there are other drugs on our formulary that require prior authorization to determine whether they are covered under Medicare Part B instead of Part D. To view the prior authorization criteria, please click here.

Providers or their agent(s) may initiate requests for formulary exceptions or authorizations via:

  • Security Health Plan Pharmacy request line at 1-877-873-5611 or 715-221-9604 
  • Security Health Plan Pharmacy fax number at 715-221-9989 
  • Security Health Online (requires login with user name and password)

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.