• Drugs with Special Requirements

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.

If your physician believes that you require a certain medication that is not on your formulary, normally requires step therapy, or exceeds a quantity limit, he or she may request an exception through the preauthorization process.​​​

The following list is for members with commercial plans. Medications with special requirements for Medicare and Medicaid are listed separately.

Commercial Plans - Drugs with Special Requirements

Brand NameGeneric NameSpecial RequirementBenefit
AbilifyaripiprazoleStep TherapyPharmacy Benefit
Abraxanealbumin-bound paclitaxelPreauthorizationInjectable Drug Benefit
Abstralfentanyl sublingual tabletsPreauthorizationPharmacy Benefit
AciphexraberprazoleStep TherapyPharmacy Benefit
ActemratocilizumabPreauthorizationInjectable Drug Benefit
Actharrepository corticotrophin injectionPreauthorizationInjectable Drug Benefit
Actimmuneinterferon Gamma-1BPreauthorizationInjectable Drug Benefit
Actiqfentanyl citratePreauthorizationPharmacy Benefit
ActonelrisedronateStep TherapyPharmacy Benefit
Adcetrisbrentuximab vedotinPreauthorizationInjectable Drug Benefit
AdcircatadalafilPreauthorizationPharmacy Benefit
AdoxadoxycyclinePreauthorizationPharmacy Benefit
Advicorniacin-lovastatin srStep TherapyPharmacy Benefit
AfinitoreverolimusPreauthorizationPharmacy Benefit
AlimtapemetrexedPreauthorizationInjectable Drug Benefit
AmbienzolpidemStep TherapyPharmacy Benefit
AmpyradalfampridinePreauthorizationPharmacy Benefit
Amrixcyclobenzaprine HCIStep TherapyPharmacy Benefit
Amturnidealiskiren, amlodipine, and hydrochlorothiazideStep TherapyPharmacy Benefit
Androdermtestosterone patchPreauthorizationPharmacy Benefit
AndrogeltestosteronePreauthorizationPharmacy Benefit
Aplenzinbupropion HBRStep TherapyPharmacy Benefit
ArcalystrilonaceptPreauthorizationInjectable Drug Benefit
ArzerraofatumumabPreauthorizationInjectable Drug Benefit
Atacandcandesartan cilexetilStep TherapyPharmacy Benefit
Atacand HCTcandesartan cilexetil-HCTZStep TherapyPharmacy Benefit
AubagioTeriflunomide TabPreauthorizationPharmacy Benefit
Avalideirbesartan-HCTZStep TherapyPharmacy Benefit
Avaproirbesartan Step TherapyPharmacy Benefit
AvastinbevacizumabPreauthorizationInjectable Drug Benefit
Avinzamorphine sulfateStep TherapyPharmacy Benefit
AxirontestosteronePreauthorizationPharmacy Benefit
Azoramlodipine besylate-olmesartan medoxomilStep TherapyPharmacy Benefit
BanzelRufinamidePreauthorizationPharmacy Benefit
Benicarolmesartan medoxomilStep TherapyPharmacy Benefit
Benicar HCTolmesartan medoxomil-HCTZStep TherapyPharmacy Benefit
BenlystabelimumabPreauthorizationInjectable Drug Benefit
BerinertC1 Esterase Inhibitor (HUMAN) PreauthorizationInjectable Drug Benefit
Betaseroninterferon beta-1bPreauthorizationInjectable Drug Benefit
BexxarTositumomabPreauthorizationInjectable Drug Benefit
Boniva (injectable)ibandronatePreauthorizationInjectable Drug Benefit
BosulifBosutinibPreauthorizationPharmacy Benefit
Botoxbotulinum toxin, type APreauthorizationInjectable Drug Benefit
ButransbuprenorphineStep TherapyPharmacy Benefit
ByettaexenatideStep TherapyPharmacy Benefit
Caduetatorvastatin/amlodipineStep TherapyPharmacy Benefit
CampathalemtuzumabPreauthorizationInjectable Drug Benefit
CaprelsavandetanibPreauthorizationPharmacy Benefit
Caystoninhaled aztreonamPreauthorizationPharmacy or Injectable Drug Benefit
CelexacitalopramStep TherapyPharmacy Benefit
CerezymeImiglucerasePreauthorizationInjectable Drug Benefit
Cimziacertulizumab pegolPreauthorizationInjectable Drug Benefit
CinryzeC1 Esterase InhibitorPreauthorizationInjectable Drug Benefit
Crestor 5mgrosuvastatinStep TherapyPharmacy Benefit
CymbaltaduloxetineStep TherapyPharmacy Benefit
Dexilant (formerly Kapidex)dexlansoprazoleStep TherapyPharmacy Benefit
DificidFidaxomicinPreauthorizationPharmacy Benefit
Diovan/Diovan HCTvalsartan/valsartan/HCTZStep TherapyPharmacy Benefit
Doryxdoxycycline DRPreauthorizationPharmacy Benefit
DynacinminocyclineStep TherapyPharmacy Benefit
Dysportbotulinum toxinPreauthorizationInjectable Drug Benefit
Edarbi azilsartan medoxomilStep TherapyPharmacy Benefit
Edarbyclorazilsartan medoxomil-chlorthalidoneStep TherapyPharmacy Benefit
Effexor and Effexor XRvenlafaxineStep TherapyPharmacy Benefit
EgriftatesamorelinPreauthorizationInjectable Drug Benefit
ElelysoTaliglucerase Alfa PreauthorizationInjectable Drug Benefit
ElidelpimecrolimusStep TherapyPharmacy Benefit
Embedamorphine sulfate & naltrexone hydrochlorideStep TherapyPharmacy Benefit
EmsamselegilineStep TherapyPharmacy Benefit
ErbituxcetuximabPreauthorizationChemotherapy Benefit
ErivedgevismodegibPreauthorizationPharmacy Benefit
Erwinazeasparaginase Erwinia chrysanthemiPreauthorizationInjectable Drug Benefit
Exalgohydromorphone ERStep TherapyPharmacy Benefit
Exforge/Exforge HCTamlodipine-valsartan/amlodipine-valsartan-HCTZStep TherapyPharmacy Benefit
Extaviainterferon beta-1bPreauthorizationInjectable Drug Benefit
EyleaafliberceptPreauthorizationInjectable Drug Benefit
FanaptiloperidoneStep TherapyPharmacy Benefit
Fentanyl (transmucosal citrate buccal tablet and buccal soluble film)fentanylPreauthorizationPharmacy Benefit
Fentorafentanyl buccal tabletPreauthorizationPharmacy Benefit
FirazyrIcatibantPreauthorizationInjectable Drug Benefit
FolotynpralatrexatePreauthorizationInjectable Drug Benefit
Forteoteriparatide recombinant injectionPreauthorizationInjectable Drug Benefit
FortestatestosteronePreauthorizationPharmacy Benefit
FosamaxalendronateStep TherapyPharmacy Benefit
General Exception Form: Use when a specific form does not exist.not applicablePreauthorization and Step TherapyPharmacy Benefit
Genotropin (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
GilenyafingolimodPreauthorizationPharmacy Benefit
Halaveneribulin mesylatePreauthorizationInjectable Drug Benefit
Humatrope (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
Hyalgan (non-preferred viscosupplement)hyaluronatePreauthorizationInjectable Drug Benefit
IlariscanakinumabPreauthorizationInjectable Drug Benefit
IncivektelaprevirPreauthorizationPharmacy Benefit
IncrelexmecaserminPreauthorizationInjectable Drug Benefit
InlytaaxitinibPreauthorizationPharmacy Benefit
InspraeplerenoneStep TherapyPharmacy Benefit
Intravenous Immunoglobulin (IVIG)immune globulinPreauthorizationInjectable Drug Benefit
InvegapaliperidoneStep TherapyPharmacy Benefit
IstodaxromidepsinPreauthorizationInjectable Drug Benefit
IxempraixabepilonePreauthorizationInjectable Drug Benefit
JakafiruxolitinibPreauthorizationPharmacy Benefit
JevtanacabazitaxelPreauthorizationInjectable Drug Benefit
Kadianmorphine sulfateStep TherapyPharmacy Benefit
KalbitorecallantidePreauthorizationInjectable Drug Benefit
KalydecoivacaftorPreauthorizationPharmacy Benefit
Kineret (patient must have met the criteria for and tried either Enbrel or Remicade)anakinraPreauthorizationInjectable Drug Benefit
KorlymmifepristonePreauthorizationPharmacy Benefit
KrystexxapegloticasePreauthorizationInjectable Drug Benefit
Latudalurasidone HCLStep TherapyPharmacy Benefit
Lazandafentanyl nasal sprayPreauthorizationPharmacy Benefit
LetairisambrisentanPreauthorizationPharmacy Benefit
LexaproescitalopramStep TherapyPharmacy Benefit
LipitoratorvastatinStep TherapyPharmacy Benefit
LivalopitavastatinStep TherapyPharmacy Benefit
LucentisranibizumabPreauthorizationInjectable Drug Benefit
LunestaeszopicloneStep TherapyPharmacy Benefit
MacugenpegaptanibPreauthorizationInjectable Drug Benefit
Makenahydroxyprogesterone caproate 17PPreauthorizationInjectable Drug Benefit
MarquiboVincristine Sulfate LiposomePreauthorizationInjectable Drug Benefit
MicardistelmisartanStep TherapyPharmacy Benefit
Micardis HCTtelmisartan-HCTZStep 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
Nuedextadextromethorphan/quinidinePreauthorizationPharmacy Benefit
NulojixbelataceptPreauthorizationInjectable Drug Benefit
Nutropin (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
Nutropin AQ (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
NuvigilarmodafinilPreauthorizationPharmacy Benefit
Omnitrope (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
OmontyspeginesatidePreauthorizationInjectable Drug Benefit
OnficlobazamPreauthorizationPharmacy Benefit
Onsolisfentanyl buccal soluble filmPreauthorizationPharmacy Benefit
Opana ERoxymorphone HCL immediate and extended releaseStep TherapyPharmacy Benefit
Opioid High-Quantity Requestany opioid (narcotic)PreauthorizationPharmacy Benefit
OraceadoxycyclinePreauthorizationPharmacy 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
Paxil Suspensionparoxetine suspStep TherapyPharmacy Benefit
Pegasys (Hep B)peginterferon alfa-2APreauthorizationInjectable Drug Benefit
Pegasys (Hep C)peginterferon alfa-2APreauthorizationPharmacy Benefit
PEG-Intron (Hep B)peginterferon alfa-2APreauthorizationInjectable Drug Benefit
PEG-Intron (Hep C)peginterferon alfa-2APreauthorizationInjectable Drug Benefit
PeriostatdoxycyclinePreauthorizationPharmacy Benefit
Pexevaparoxetine mesylateStep TherapyPharmacy Benefit
Pregnylchorionic gonadotropinPreauthorizationInjectable Drug Benefit
PrevacidlansoprazoleStep TherapyPharmacy Benefit
Prialtziconotide acetate injectionPreauthorizationInjectable Drug Benefit
Prilosec*omeprazoleStep TherapyPharmacy Benefit
PristiqdesvenlafaxineStep TherapyPharmacy Benefit
ProliadenosumabPreauthorizationInjectable Drug Benefit
PromactaeltrombopagPreauthorizationPharmacy Benefit
ProtonixpantoprazoleStep TherapyPharmacy Benefit
ProtopictacrolimusStep TherapyPharmacy Benefit
Provengesipuleucel-TPreauthorizationInjectable Drug Benefit
ProvigilmodafinilPreauthorizationPharmacy Benefit
Prozac and Prozac WeeklyfluoxetineStep TherapyPharmacy Benefit
Qutenzacapsaicin 8%PreauthorizationPharmacy or Injectable Drug Benefit
RanexaranolazineStep TherapyPharmacy Benefit
Reclastzoledronic acidePreauthorizationInjectable Drug Benefit
RelistormethylnaltrexonePreauthorizationInjectable Drug Benefit
RemeronmirtazapineStep TherapyPharmacy Benefit
Revatiosildenafil citratePreauthorizationPharmacy Benefit
RevlimidlenalidomidePreauthorizationPharmacy Benefit
SabrilvigabatrinPreauthorizationPharmacy Benefit
Saizen (preferred growth hormone brand)somatropinPreauthorizationInjectable Drug Benefit
SamscatolvaptanPreauthorizationPharmacy Benefit
SaphrisasenapineStep TherapyPharmacy Benefit
SarafemfluoxetineStep TherapyPharmacy Benefit
Serostim (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
SilenordoxepinStep TherapyPharmacy Benefit
Simcorniacin simvastatinStep TherapyPharmacy Benefit
SimponigolimumabPreauthorizationInjectable Drug Benefit
SingulairmontelukastStep TherapyPharmacy Benefit
SoliriseculizumabPreauthorizationInjectable Drug Benefit
Solodynminocycline ERPreauthorizationPharmacy Benefit
SomacarisoprodolStep TherapyPharmacy Benefit
Somatulinelanreotide acetatePreauthorizationInjectable Drug Benefit
SomavertpegvisomantPreauthorizationInjectable Drug Benefit
SonatazaleplonStep TherapyPharmacy Benefit
SpryceldasatinibPreauthorizationPharmacy Benefit
StelaraustekinumabPreauthorizationInjectable Drug Benefit
StivargaRegorafenibPreauthorizationPharmacy Benefit
StrianttestosteronePreauthorizationPharmacy Benefit
Subsyssublingual sprayPreauthorizationPharmacy Benefit
Supartz (non-preferred growth viscosupplement)sodium hyaluronatePreauthorizationInjectable Drug Benefit
SutentsunitinibPreauthorizationPharmacy Benefit
Sylatronpeginterferon alfa-2bPreauthorizationInjectable Drug Benefit
Symlin Pen 60pramlintide acetateStep TherapyPharmacy Benefit
SynagispalivizumabPreauthorizationInjectable Drug Benefit
TarcevaerlotinibPreauthorizationPharmacy Benefit
TasignanilotinibPreauthorizationPharmacy Benefit
Tekamloaliskiren and amlodipineStep TherapyPharmacy Benefit
TekturnaaliskirenStep TherapyPharmacy Benefit
TestimtestosteronePreauthorizationPharmacy Benefit
Teveteneprosartan mesylateStep TherapyPharmacy Benefit
Teveten HCTeprosartan mesylate-HCTZStep TherapyPharmacy Benefit
Tev-Tropin (preferred growth hormone)somatropin (rDNA origin)PreauthorizationInjectable Drug Benefit
ThalomidthalidomidePreauthorizationPharmacy Benefit
Tobiinhaled tobramycinPreauthorizationPharmacy or Injectable Drug Benefit
ToriseltemsirolimusPreauthorizationInjectable Drug Benefit
TracleerbosentanPreauthorizationPharmacy Benefit
Treandabendamustine hydrochloridePreauthorizationInjectable Drug Benefit
Tribenzorolmesartan-amlodipine-HCTZStep TherapyPharmacy Benefit
Twynstatelmisartan-amlodipineStep TherapyPharmacy Benefit
TykerblapatinibPreauthorizationPharmacy Benefit
TysabrinatalizumabPreauthorizationInjectable Drug Benefit
TyvasotreprostinilPreauthorizationPharmacy or Injectable Drug Benefit
VectibixpanitumumabPreauthorizationInjectable Drug Benefit
VelcadebortezomibPreauthorizationInjectable Drug Benefit
VentavisiloprostPreauthorizationPharmacy or Injectable Drug Benefit
Victozaliraglutide rDNA injectionStep TherapyPharmacy Benefit
VictrelisboceprevirPreauthorizationPharmacy Benefit
Vimovonaproxen and esomeprazole magnesiumStep TherapyPharmacy Benefit
VotrientpazopanibPreauthorizationPharmacy Benefit
VPRIVVelaglucerase AlfaPreauthorizationInjectable Drug Benefit
Vytorinezetimibe-simvastatinStep TherapyPharmacy Benefit
Wellbutrin, Wellbutrin SE, and Wellbutrin XLbupropionStep TherapyPharmacy Benefit
XalkoricrizotinibPreauthorizationPharmacy Benefit
XenazinetetrabenazinePreauthorizationPharmacy Benefit
XeominincobotulinumtoxinAPreauthorizationInjectable Drug Benefit
XgevadenosumabPreauthorizationInjectable Drug Benefit
Xiaflexcollagenase clostridium histolyticumPreauthorizationInjectable Drug Benefit
XifaxanrifaximinPreauthorizationPharmacy Benefit
XolairomalizumabPreauthorizationInjectable Drug Benefit
XtandiEnzalutamidePreauthorizationPharmacy Benefit
Xyremsodium oxybate (GHB)PreauthorizationPharmacy Benefit
YervoyipilimumabPreauthorizationInjectable Drug Benefit
ZaltrapZiv-Aflibercept IV Soln PreauthorizationInjectable Drug Benefit
ZegeridomeprazoleStep TherapyPharmacy Benefit
ZelborafvemurafenibPreauthorizationPharmacy Benefit
ZenapaxdaclizumabPreauthorizationInjectable Drug Benefit
ZevalinIbritumomab TiuxetanPreauthorizationInjectable Drug Benefit
ZolinzavorinostatPreauthorizationPharmacy Benefit
ZoloftsertralineStep TherapyPharmacy Benefit
Zorbtive (non-preferred growth hormone)somatropinPreauthorizationInjectable Drug Benefit
Zytigaabiraterone acetatePreauthorizationPharmacy Benefit