PROVIDERS: PAs may be submitted via the phone, 800-313-7879 or online, https://ExpressPA.pahub.com.
| program | description | reference |
|---|---|---|
| Prior Approval |
We require providers to request prior approval for certain medications.
|
Prior Approval List |
| Quantity Limits |
Providers may need to provide documentation if a prescription amount exceeds our criteria.
|
Quantity Limits List |
| Step Therapy |
Providers should always try less expensive drugs before using the newest, most expensive drugs.
|
Step Therapy List |
| Tier | Description | CO-PAY |
|---|---|---|
| Tier 1 | Generic drugs | LOWEST |
| Tier 2 | Brands on Preferred Brand Name Drug List | MIDDLE |
| Tier 3 | Brands with NO generic, or NOT on Preferred Brand Name Drug List |
HIGHEST |