Medicare Medications That Require
Prior Authorization

(A-G)

Click on a link below to see a full list of forms available.
A-G H-N O-Z

If the prescribed medication is not listed below please use the generic form.

Accuneb Solution	Chantix
Acetylcysteine Inhalation Solution	Chorionic Gonadotropin
Actemra	Cimzia
Actimmune	Colcrys
Actiq	Colistimethate solution
Adcirca	Coly-Mycin M
Albuterol Sulfate Solution	Copaxone
Amerge (post limit)	Copegus
Amitiza (step therapy)	Cromolyn Sodium solution
Amphetamines	Cubicin
Ampyra	Cyclophosphamide
Anagrelide	Cyclosporine
Androgel	Dolophine (post limit)
Androxy	Dronabinol (initial)
Aralast NP	Dronabinol (post limit)
Aranesp	Duoneb solution
Arcalyst	Duragesic (post limit)
Atgam	Elidel
Atypical Antipsychotics (step therapy)	Emend 80mg or 125mg
Avinza ER (post limit)	Emsam
Avonex	Enbrel
Axert (post limit)	Enoxaparin (post limit)
Axiron	Eplerenone
Azathioprine	Erivedge
Betaseron	Exalgo PL
Bone Mineral Metabolism Agents	Exjade
Botox	Fentanyl oral
Brilinta	Fentanyl patch (post limit)
Brovana solution	Fentanyl Patch Initial
Budesonide	Ferriprox
Buprenorphine	Forteo
Butorphanol NS (post limit)	Fortesta
Byetta	Frova (post limit)
Cayston	Gilenya
Celebrex	Gleevec
Cellcept	Granisetron & Ondanestron B vs D
Cesamet (post limit)	Growth Hormone

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Arkansas Blue Cross and Blue Shield