Drug Management Programs
If your doctor prescribes a medication that is included in our Prior Authorization program, you must get prior approval before your plan will cover your medication. You can find out what these drugs are by viewing our Prior Authorization Drug List.
This program limits the amount of certain drugs a member’s plan will cover. You can see which drugs have quantity limits by viewing our Quantity Management Drug List.
Step Therapy requires members to try cost-effective “First Choice” medications before trying (or "stepping up to") more expensive “Second Choice” medications. Many people find the First Choice medications work just as well for them. View the Step Therapy Drug List.
Specialty Drugs are high-cost prescription medications used to treat complex or chronic medical conditions, like cancer, rheumatoid arthritis, multiple sclerosis and hepatitis, just to name a few. They are often self-injected and usually require patient-specific dosing and careful clinical monitoring. They may also require special handling and refrigeration. (View the Specialty Drug List.) CVS/specialty, a division of CVS/Health, is an independent company that provides specialty pharmacy services on behalf of PAI.