Medicare Medications That Require
Prior Authorization

(O-Z)

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.

Octreotide	Stelara
Onsolis	Striant
Opana ER (post limit)	Suboxone
Orencia	Sumatriptan injection (post limit)
Oxandrolone	Sumatriptan nasal spray (post limit)
Oxycontin (post limit)	Sumatriptan oral (post limit)
Peg-Intron	Sutent
Pegasys	Sylatron
Perforomist solution	Symlin
Procrit & Epogen	Tarceva
Prograf	Targretin
Prolastin	Tasigna
Promacta	Testim
Protopic	Tetanus injection
Provigil	Thalomid
Pulmicort Respules	Thymoglobulin
Pulmozyme Solution B vs D	Tobi
Ranexa	Tracleer
Rapamune	Trexall
Rebetol oral solution	Treximet (post limit)
Rebif	Tysabri
Regranex	Uloric (step therapy)
Relistor	Vancomycin
Relpax (post limit)	Ventavis
Remicade	Victrelis
Revatio tabs	Vpriv
Revlimid	Xalkori
Ribavirin	Xenazine
Risperdal Consta	Xgeva
Rituxan	Xifaxan
Sabril	Xolair
Sandimmune	Xopenex
Sandostatin LAR	Xyrem
Sedative-Hypnotic (post limit)	Zelboraf
Serostim	Zemaira
Simponi	Zomig (post limit)
Simulect	Zorbtive
Somatuline	Zortress
Somavert	Zuplenz
Sporanox	Zytiga
Sprycel

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Arkansas Blue Cross and Blue Shield