Prior Authorization & Medication Quantity Limits

To promote proper use of medications, while deterring unproven or experimental uses, RegenceRx has implemented prior authorization and quantity level limits for select medications.

RegenceRx pharmacists and physicians check for medications that:

• May be prone to overuse or are used longer or in higher quantities than are recommended.
• Have other less expensive medications that may be an option.
• Have limited uses based on scientific studies or FDA approval.
• May be prescribed for conditions that are not a covered benefit.
• Require medical diagnostic tests to ensure a medical benefit.

For specific information, please refer to our RegenceRx Prior Authorization and Quantity Limit listings. Choose your plan from the following list:

• RegenceRx
• Regence BlueShield of Idaho
• Regence BlueCross BlueShield of Oregon
• Regence BlueCross BlueShield of Utah
• Regence BlueShield (Washington)
• Asuris Northwest Health

RegenceRx Clinical Pharmacists and Medical Directors review prior authorization requests from prescribers. We respond in writing (usually by fax) to the prescriber, pharmacy, and the member within 24 to 48 hours. We also include detailed information about the rationale if a request was denied and educational information when available.

Quick, Automated Approvals
We’ve also established an efficient process for automating authorizations. Claims are approved instantly when certain criteria are met based on previous prescription claims. This process eliminates the need for the doctor to submit information for review. By doing this, we’ve decreased manual approvals by 25%, eliminated costs and improved customer service.

If your medication requires prior authorization and you are wondering what formulary alternatives are available, please refer to the Preferred Medication Alternatives list or our RxPrice Guide for other options.

Questions
For questions about your prescription medication benefits, please call Customer Service at the number on the back of your member card, or the TTY line for people with hearing impairments at 1 (800) 382-1003. We encourage you to share this information with your physician or other medical provider.