When a drug requires "prior authorization," it means a set of criteria must be met for your medication to be covered by the plan.
Drugs listed below require a prior authorization for coverage determination.
Click on the drug name to print the appropriate form, which should be completed, signed and faxed by the physician to the number shown at the bottom of the form. Incomplete forms will be returned to the physician, which will delay the coverage determination. Once a coverage determination has been made, the member and/or physician will be notified.
Please refer to this page each time a form is required. Forms are revised periodically.
*Refers to a drug that's not covered under all plans.
Some drugs listed here are not included in the drug formulary for certain salaried, management, non-bargained hourly and bargained hourly employees/retirees. Refer to the Caterpillar Drug Formulary to identify drugs that are covered under your prescription drug benefit, or contact Magellan Rx Management at 1-877-228-7909 to request a printed copy of the formulary.