Prevea360 Medicare Advantage Drugs with Special Requirements
Some drugs have special requirements that must be met before Prevea360 Medicare Advantage will cover them. Those requirements are:
- Step therapy drugs require your provider to first prescribe alternative options that are generally more cost effective without compromising quality. Step therapy may be waived if determined to be medically necessary.
- Prior authorization is required for certain drugs. This process must be completed by your doctor before you fill your prescription.
You may access prior authorization and step therapy forms linked in the table below. This list is organization by drug brand name/class of drug.
If your physician believes that you require a certain medication that is not on your formulary, normally requires step therapy or exceeds a quantity limit, he or she may request an exception through the preauthorization process.
- Requests for coverage may be denied or dismissed unless all required information is received.
- Your provider’s office will receive a response via fax.
- For urgent requests, call 1-866-270-3877 (TTY: 711).
Medicare D Coverage Determination form
Hospice Primary Billing form
BvD ESRD dialysis-related drugs
BvD TPN, IDPN, IPN
See the rest of our list of drugs with special requirements.