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PHARMACY POLICIES - GENERAL
Wellness Plan Formulary Effective 1/1/2018
PHARMACY POLICIES - COMMERCIAL MEMBERS
Specialty Drug List All unclassified drug codes (such as J3490, J3590, J8999 and J9999) require prior authorization. When requesting authorization for an unclassified drug, please submit the NDC#, Drug Name, and Dosage. Other Specialty Medications not listed on this list may be covered under your medical benefits. If covered, these drugs are subject to the cost-sharing specified in Attachment A and may be subject to Prior Authorization.
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