For members enrolled in an IBC prescription drug program, prior authorization
and quantity limit requirements will be applied to certain 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
Aubagio
?
Not available
Pain, Nervous System, & Psych
September 28, 2012
Qsymia
TM
Not available
Diagnostics & Miscellaneous
September 7, 2012
Stivarga
?
Not available
Cancer & Organ Transplant Drugs
September 28, 2012
The following prior authorization requirements for the following
non-formulary
drugs are effective at the time indicated below:
Brand drug
Generic drug
Drug category
Effective date
Solodyn
?
Not available
Antibiotics & Other Drugs Used for
Infection
April 1, 2013
Xyrem
?
Not available
Pain, Nervous System, & Psych
April 1, 2013
Drug with quantity limits
Quantity limits
will be added for the following drug:
Effective April 1, 2013.
Brand drug
Generic drug
Drug category
Quantity limit
(per 30 days)
Xyrem
?
Not available
Pain, Nervous System, & Psych
540ml