• Drugs with Special Requirements

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Some drugs have special requirements that must be met before SelectHealth will cover them.

  • Step therapy drugs require your provider to first prescribe alternative options that are generally more cost effective without compromising quality. Step therapy may be waived if determined to be medically necessary.
  • Preauthorization is required for certain drugs. This process must be completed by your doctor before you fill your prescription.
Brand NameGeneric NameSpecial RequirementBenefit
AciphexraberprazoleStep TherapyPharmacy Benefit
ActemratocilizumabPreauthorizationInjectable Drug Benefit
Actimmuneinterferon Gamma-1BPreauthorizationInjectable Drug Benefit
Actiqfentanyl citrate lollipopPreauthorizationPharmacy Benefit
ActonelrisedronateStep TherapyPharmacy Benefit
AdcircatadalafilPreauthorizationPharmacy Benefit
AfinitoreverolimusPreauthorizationPharmacy Benefit
AlimtapemetrexedPreauthorizationInjectable Drug Benefit
AmbienzolpidemStep TherapyPharmacy Benefit
AmpyradalfampridinePreauthorizationPharmacy Benefit
Amrixcyclobenzaprine HCIStep TherapyPharmacy Benefit
Androdermtestosterone patchStep TherapyPharmacy Benefit
Aplenzinbupropion HBRStep TherapyPharmacy Benefit
ArcalystrilonaceptPreauthorizationInjectable Drug Benefit
ArzerraofatumumabPreauthorizationInjectable Drug Benefit
AtacandcandesartanStep TherapyPharmacy Benefit
Avalideirbesartan/HCTZStep TherapyPharmacy Benefit
AvastinbevacizumabPreauthorizationInjectable Drug Benefit
Azoramlodipine besylate-olmesartan medoxomilStep TherapyPharmacy Benefit
Benicar/Benicar HCTolmesartan/olmesartan HCTZStep TherapyPharmacy Benefit
BerinertC1 esterase inhibitorPreauthorizationInjectable Drug Benefit
Betaseroninterferon beta-1bPreauthorizationInjectable Drug Benefit
Boniva (injectable)ibandronatePreauthorizationInjectable Drug Benefit
Botoxbotulinum toxin, type APreauthorizationInjectable Drug Benefit
ByettaextnatideStep TherapyPharmacy Benefit
Caduetatorvastatin/amlodipineStep TherapyPharmacy Benefit
CampathalemtuzumabPreauthorizationInjectable Drug Benefit
Caystoninhaled aztreonamPreauthorizationPharmacy or Injectable Drug Benefit
CelexacitalopramStep TherapyPharmacy Benefit
Cimziacertulizumab pegolPreauthorizationInjectable Drug Benefit
CinryzeC1 Esterase InhibitorPreauthorizationInjectable Drug Benefit
Crestor 5mgrosuvastatinStep TherapyPharmacy Benefit
CymbaltaduloxetineStep TherapyPharmacy Benefit
Dexilant (formerly Kapidex)dextansoprazoleStep TherapyPharmacy Benefit
DoryxdoxycyclineStep TherapyPharmacy Benefit
Dysportbotulinum toxinPreauthorizationInjectable Drug Benefit
Effexor and Effexor XRvenlafaxineStep TherapyPharmacy Benefit
ElidelpimecrolimusStep TherapyPharmacy Benefit
Embedamorphine sulfate & naltrexone hydrochlorideStep TherapyPharmacy Benefit
EmsamselegilineStep TherapyPharmacy Benefit
ErbituxcetuximabPreauthorizationChemotherapy Benefit
Exalgohydromorphone ERStep TherapyPharmacy Benefit
Extaviainterferon beta-1bPreauthorizationInjectable Drug Benefit
Fentanyl (transmucosal citrate buccal tablet and buccal soluble film)fentanylPreauthorizationPharmacy Benefit
Fentorafentanyl buccal tabletPreauthorizationPharmacy Benefit
Flolanepoprostenol sodiumPreauthorizationInjectable Drug Benefit
FolotynpralatrexatePreauthorizationInjectable Drug Benefit
Forteoteriparatide recombinant injectionPreauthorizationInjectable Drug Benefit
Genotropin (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
Humatrope (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
Hyalgan (non-preferred viscosupplement)hyaluronatePreauthorizationInjectable Drug Benefit
IlariscanakinumabPreauthorizationInjectable Drug Benefit
IncrelexmecaserminPreauthorizationInjectable Drug Benefit
InspraeplerenoneStep TherapyPharmacy Benefit
Intravenous Immunoglobulin (IVIG)immune globulinPreauthorizationInjectable Drug Benefit
IressagefitinibPreauthorizationPharmacy Benefit
IstodaxromidepsinPreauthorizationInjectable Drug Benefit
IxempraixabepilonePreauthorizationInjectable Drug Benefit
KalbitorecallantidePreauthorizationInjectable Drug Benefit
Kineret (patient must have met the criteria for and tried either Enbrel or Remicade)anakinraPreauthorizationInjectable Drug Benefit
LetairisambrisentanPreauthorizationPharmacy Benefit
LexaproescitalopramStep TherapyPharmacy Benefit
LipitoratorvastatinStep TherapyPharmacy Benefit
LunestaeszopicloneStep TherapyPharmacy Benefit
MicardistelmisartanStep TherapyPharmacy Benefit
MinocinminocyclineStep TherapyPharmacy Benefit
MyoBlocbotulinum toxin, type BPreauthorizationInjectable Drug Benefit
NexavarsorafenibPreauthorizationPharmacy Benefit
NexiumesomeprazoleStep TherapyPharmacy Benefit
Norditropin (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
NPlateromiplostimPreauthorizationInjectable Drug Benefit
NucyntatapentadolStep TherapyPharmacy Benefit
Nutropin (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
Nutropin AQ (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
Nutropin Depot (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
NuvigilarmodafinilPreauthorizationPharmacy Benefit
Omnitrope (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
Onsolisfentanyl buccal soluble filmPreauthorizationPharmacy Benefit
Opanaoxymorphone HCL immediate and extended releaseStep TherapyPharmacy Benefit
Opioid High-Quantity Requestany opioid (narcotic)PreauthorizationPharmacy Benefit
OraceadoxycyclineStep TherapyPharmacy Benefit
OrenciaabataceptPreauthorizationInjectable Drug Benefit
Orthovisc (non-preferred viscosupplement)hyaluronic acidPreauthorizationInjectable Drug Benefit
OvidrelchorionicPreauthorizationInjectable Drug Benefit
OxycontinoxycodoneStep TherapyPharmacy Benefit
Paxil and Paxil CRparoxetine HCLStep TherapyPharmacy Benefit
Pegasyspeginterferon alfa-2APreauthorizationInjectable Drug Benefit
PEG-Intronpeginterferon alfa-2APreauthorizationInjectable Drug Benefit
Pexevaparoxetine mesylateStep TherapyPharmacy Benefit
Pregnylchorionic gonadotropinPreauthorizationInjectable Drug Benefit
PrevacidlansoprazoleStep TherapyPharmacy Benefit
Prialtziconotide acetate injectionPreauthorizationInjectable Drug Benefit
Prilosec*omeprazoleStep TherapyPharmacy Benefit
PristiqdevenlafaxineStep TherapyInjectable Drug Benefit
Profasichorionic gonadotropinPreauthorizationInjectable Drug Benefit
Progesterone (Prometrium) all forms including powder, suppository, hydroxy-projesterone, etc (preauth not required for patients ages 40 and older)micronized progesteronePreauthorizationPharmacy or Injectable Drug Benefit
ProliadenosumabPreauthorizationInjectable Drug Benefit
PromactaeltrombopagPreauthorizationPharmacy Benefit
Proton Pump Inhibitors (PPIs)omeprazoleStep TherapyPharmacy Benefit
ProtonixpantoprazoleStep TherapyPharmacy Benefit
ProtopictacrolimusStep TherapyPharmacy Benefit
Protropin (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
Provengesipuleucel-TPreauthorizationInjectable Drug Benefit
ProvigilmodafinilPreauthorizationPharmacy Benefit
Prozac and Prozac WeeklyfluoxetineStep TherapyPharmacy Benefit
RanexaranolazineStep TherapyPharmacy Benefit
RapifluxfluoxetineStep TherapyPharmacy Benefit
Reclastzoledronic acidePreauthorizationInjectable Drug Benefit
RelistormethylnaltrexonePreauthorizationInjectable Drug Benefit
RemeronmirtazapineStep TherapyPharmacy Benefit
Remodulintreprostinil sodiumPreauthorizationInjectable Drug Benefit
Revatiosildenafil citratePreauthorizationPharmacy Benefit
RevlimidlenalidomidePreauthorizationPharmacy Benefit
SabrilvigabatrinPreauthorizationPharmacy Benefit
Saizen (preferred growth hormone brand)somatropinPreauthorizationInjectable Drug Benefit
SarafemfluoxetineStep TherapyPharmacy Benefit
Serostim (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
Simcorniacin simvastatinStep TherapyPharmacy Benefit
SimponigolimumabPreauthorizationInjectable Drug Benefit
SingulairmontelukastStep TherapyPharmacy Benefit
SoliriseculizumabPreauthorizationInjectable Drug Benefit
SolodynminocyclineStep TherapyPharmacy Benefit
SomacarisoprodolStep TherapyPharmacy Benefit
SomatulinepegvisomantPreauthorizationInjectable Drug Benefit
SomavertpegvisomantPreauthorizationInjectable Drug Benefit
SonatazaleplonStep TherapyPharmacy Benefit
SpryceldasatinibPreauthorizationPharmacy Benefit
StelaraustekinumabPreauthorizationInjectable Drug Benefit
Supartz (non-preferred growth viscosupplement)sodium hyaluronatePreauthorizationInjectable Drug Benefit
SutentsunitinibPreauthorizationPharmacy Benefit
Symlin Pen 60pramlintide acetateStep TherapyPharmacy Benefit
SynagispalivizumabPreauthorizationInjectable Drug Benefit
TarcevaerlontinibPreauthorizationPharmacy Benefit
TasignanilotinibPreauthorizationPharmacy Benefit
TekturnaaliskirenStep TherapyPharmacy Benefit
Testimtestosterone gelStep TherapyPharmacy Benefit
Teveten/HCTeprosartan/eprosartan HCTZStep TherapyPharmacy Benefit
Tev-Tropin (preferred growth hormone)somatropin (rDNA origin)PreauthorizationInjectable Drug Benefit
Tobiinhaled tobramycinPreauthorizationPharmacy or Injectable Drug Benefit
ToriseltemsirolimusPreauthorizationInjectable Drug Benefit
TracleerbosentanPreauthorizationPharmacy Benefit
Treandabendamustine hydrochloridePreauthorizationInjectable Drug Benefit
Tykerb TMlapatinibPreauthorizationPharmacy Benefit
TysabrinatalizumabPreauthorizationInjectable Drug Benefit
TyvasotreprostinilPreauthorizationInjectable Drug Benefit
VectibixpanitumumabPreauthorizationInjectable Drug Benefit
VelcadebortezomibPreauthorizationInjectable Drug Benefit
VentavislloprostPreauthorizationInjectable Drug Benefit
VotrientpazopanibPreauthorizationPharmacy Benefit
Vytorinezetimbie-simvastatinStep TherapyPharmacy Benefit
Wellbutrin, Wellbutrin SE, and Wellbutrin XLbupropionStep TherapyPharmacy Benefit
XenazinetetrabenazinePreauthorizationPharmacy Benefit
Xiaflexcollagenase clostridium histolyticumPreauthorizationInjectable Drug Benefit
XolairomalizumabPreauthorizationInjectable Drug Benefit
Xyremsodium oxybatePreauthorizationPharmacy Benefit
ZegeridomeprazoleStep TherapyPharmacy Benefit
ZenapaxdaclizumabPreauthorizationInjectable Drug Benefit
ZolinzaverinostatPreauthorizationPharmacy Benefit
ZoloftsertralineStep TherapyPharmacy Benefit
Zorbtive (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit