Prior Authorization & Medication Quantity Limits

Regence BlueShield of Idaho

• Medication Quantity Limits
• Prior Authorization Medication List (Retail Pharmacy Benefit)
• Medical Prior-Authorization Medication List (Medical Benefit)

Medication Quantity Limits

Effective September 11, 2009
Updated October 5, 2009

* This medication is FDA approved for once a week administration only.

NOTE: In addition to the medications listed above, there are limits to the amount of medication eligible for coverage for all prescriptions. These limits are based on your prescription benefit along with information from the FDA and scientific literature about maximum, safe, effective dosage.

Prior Authorization Medication List - Retail/Prescription Benefit

Some medications may need prior authorization because better medication values are available. For example, the generic options listed in bold are the best value for most members. However, when it comes to medications, we also know that one-size may not fit all. That’s why for certain medications listed below that need prior authorization, we have an automated way to review your previous RegenceRx prescription history and automatically determine coverage for medications when certain criteria are met.

Effective February 8, 2010
Updated February 10, 2010

Prior Authorization Medication List - Given in Physician Offices/Clinics

This list applies to injectable medications covered as part of the medical benefit.  Prior authorization is required for the following medications:

Effective March 1, 2010
Updated March 1, 2010

Phone: 1 (800) 572-0316               
Fax:  1 (800) 884-4282

1. Before requesting prior authorization, please verify eligibility, benefits and medically managed delegation services through Customer Services.
2. Member contracts determine benefits. Contract exclusions will not be prior authorized.  Denials may be appealed through Customer Service.
3. Medical policies related to specific prior authorization requirements may be available online at www.regence.com/trgmedpol.

NOTE: Because scientific information changes, our medication Prior Authorization List is subject to change.
If the requested medication is authorized, there maybe limits to the amount of medication that is eligible for coverage.
Please call our Customer Service Department if you have any questions.