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For members enrolled in an IBC prescription drug program, prior authorization
and quantity limit requirements will be applied to additional drugs. The
purpose of prior authorization is to ensure that drugs are medically necessary
and are being used appropriately. Quantity limits are designed to allow a
sufficient supply of medication based upon the maximum daily dose and length of
therapy approved by the U.S. Food and Drug Administration for a particular
drug. The most recent updates are reflected below.
Drugs requiring prior authorization
The prior authorization requirement for the following non-formulary drugs was
effective at the time the drugs became available in the marketplace:
Brand drug
Generic drug
Drug category
Effective date
Caprelsa?
Not available
Cancer & Organ Transplant Drugs
April 22, 2011
ZytigaTM
Not available
Cancer & Organ Transplant Drugs
May 6, 2011
The following non-formulary drug will be added to the list of drugs requiring
prior authorization for new prescriptions. Members taking this drug immediately
prior to the effective date are not affected: Effective October 1, 2011.
Brand drug
Generic drug
Drug category
StaxynTM
Not available
Urinary & Prostate Meds
The following non-formulary drugs will be added to the list of drugs requiring
prior authorization for new prescriptions: Effective October 1, 2011.
Brand drug
Generic drug
Drug category
Androderm?
Not available
Hormones
Axiron?
Not available
Hormones
FortestaTM
Not available
Hormones
Striant?
Not available
Hormones
Testim?
Not available
Hormones
For members currently taking the above drugs, the prior authorization
requirement will not be effective until January 1, 2012.
Drugs with quantity limits
Quantity limits will be added for the following drug: Effective October 1,
2011.
Brand drug
Generic drug
Quantity limit (per 30 days)
StaxynTM
Not available
8 tablets
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