Medicare Medications That Require
Prior Authorization

(H-N)

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.

Heparin	Leuprolide injection
Hepatitis B Vaccine	Levalbuterol
Hizentra	Lidocaine Topical Products
Humira	Lidoderm
Imitrex injection (post limit)	Lipids, Amino Acids Infusion
Imitrex nasal spray (post limit)	Lumizyme
Imitrex tabs (post limit)	Lupron
Immune Globulins	Maxalt (post limit)
Imuran	Methadone & Methadose (post limit)
Incivek	Methylphenidates
Increlex	Morphine Sulfate ER (post limit)
Infergen	Mozobil
Injectable Medications	MS Contin ER (post limit)
Inlyta	Myfortic
Invega Sustenna	Naratriptan (post limit)
Ipratropium - Albuterol solution	Nebupent solution
Ipratropium Bromide solution	Neoral
Itraconazole caps	Neulasta
Jakafi	Neupogen
Kadian ER (post limit)	Nexavar
Kineret	Nuedexta
Kytril & Zofran oral	Nulojix
Letairis	Nuvigil
Leukine

Return to Authorization Forms

Arkansas Blue Cross and Blue Shield