Prescription Drugs
Prior Authorization
To be sure that certain medications are used appropriately, prior authorization (plan approval) may be required before prescriptions for these drugs can be filled. Drugs subject to Prior Authorization are marked with an “PA” code in our print and online formularies.
Prior authorization may be required for the following drugs and reasons:
- Non-formulary medications or benefit exceptions required by medical necessity
- Prescriptions that exceed set plan limits (days’ supply, quantity, cost)
- Certain brand name medications when there is an A-rated generic version available
- New-to-market products
- Medications and/or treatments if they are under clinical investigation
- Medications that have treatment guidelines developed by the Jefferson Health Plans Pharmacy & Therapeutics Committee
- Medications prescribed for non-FDA approved uses
Prior authorization requests may be submitted by the member or the provider; however, supporting clinical information is usually needed from the provider.
Call us to request prior authorization:
1-833-422-4690 (TTY 1-877-454-8477)
Requests can be faxed to:
1-833-605-4407
Members can download a request form and provide it to providers to complete to request a prior authorization.
Prescription Drugs
Still Have Questions?
If you need help or have questions about prior authorization, please call Member Relations at 1-833-422-4690 (TTY 1-877-454-8477).
From October 1 to March 31, we’re available 8 a.m. to 8 p.m., 7 days a week. And from April 1 to September 30, we’re available 8 a.m. to 8 p.m., Monday to Friday. We are closed on November 23 and December 25, 2023.