Drug authorizations
Search our online formulary tools to understand plan specific drug coverage information, including formulary status and if there are utilization management rules such as prior authorization, step therapy requirements, age limits and quantity limits.
Drugs covered under the medical benefit
View general medical drug information for medications that are covered under the medical benefit and submitted as part of professional and institutional (CMS 1500, UB-04) claims.
Coverage for medication and any applicable utilization management criteria can be found on the Medical Benefit Drug List (MBDL). Since coverage and criteria differ by plan, filter for the plan type to view the applicable information. Forms and the utilization management criteria for drugs that require authorization are linked in the MBDL.
Medical Benefit Drug List (MBDL)
Drugs covered under the pharmacy benefit
Coverage for medication and any applicable utilization management criteria can be found on the Approved Drug Lists. Since coverage and criteria differ by plan, choose the plan type to view the correct plan-approved drug list.
General drug request forms
Use these general forms when there is no drug-specific form listed.
Fax completed forms to Priority Health at 877.974.4411.
Medicare
- 2025 Medicare Part D prior authorization criteria
- Medicare Part D coverage determination request form
- Hospice/Part D drug prior authorization form
- 2025 Medicare Part D step therapy criteria
- Medicare Part B vs. Medicare Part D coverage determination form
- 2025 Medicare Part B prior authorization and step therapy criteria
- Medicare Part B prior authorization form
- Medicare Part B oncology prior authorization form