PA Resources Portlet

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Radiation Therapy Management (RTM)

Self-Administered Drug Policies

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PROVIDER NETWORKS & SPECIALTIES

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Pharmacy Drug Lists and Policies 

The following pharmacy drug lists and policies are available to assist you with your patients’ pharmaceutical needs:

Drug Policy Provider Comments Form: This form enables participating providers to submit evidence-based professional opinions relevant to draft policies for consideration. We accept comments for 45 days from the posting date listed on the policy.

FEP Prescription Drug Lists: Provides an overview of our prescription drug lists for FEP members, including typical drug tiers, Provider-Administered drug information and more.

Drug Wastage Program: Identifies specific authorizations for a targeted list of drugs and requires the dose to be rounded down (if it is within 10% of the requested dose) to allow for more efficient vial size utilization when clinically appropriate. 

Drug Wastage Program Frequently Asked Questions/Answers: Find answers to questions about the Drug Wastage Program’s expansion through Prime Therapeutics.

Prescription Drug Lists: Provides an overview of our prescription drug lists, including typical drug tiers, Provider-Administered drug information and more.

Provider-Administered Drug Policies: Policies for provider-administered drugs.

Provider-Administered Precertification Drug List: A list of provider-administered drugs that require precertification when administered in a provider’s office, outpatient facility or home health setting. Refer to this list to check if drugs require prior-authorization, must be obtained/billed by an in-network specialty pharmacy or if drugs may have limited distribution.

Provider-Administered Specialty Pharmacy Drug List: A list of provider-administered specialty medications that are generally prescribed for people with complex or ongoing medical conditions. Refer to this list to check if drugs require prior-authorization, must be obtained/billed by an in-network specialty pharmacy or if drugs may have limited distribution.

Self-Administered Drug Policies: Policies for self-administered drugs.

Self-Administered Specialty Pharmacy Drug List: A list of self-administered specialty medications that are generally prescribed for people with complex or ongoing medical conditions. Refer to this list to check if drugs require prior-authorization, must be obtained/billed by an in-network specialty pharmacy or if drugs may have limited distribution.