Formularies & drug lists
Refer to our pharmacy formularies and access preventive drug lists.
Pharmacy Medical Necessity Guidelines
Access guidelines for pharmacy drugs requiring prior authorization
View complete drug list (A-Z)Utilization management
Learn about step therapy, new-to-market evaluation, quantity limits and more.
PromptPA for authorization
Submit prior authorization requests quickly and easily with PromptPA.
Other ways to request PA
While we recommend using PromptPA, you can request authorization other ways.
- Physicians for Responsible Opioid Prescribing (PROP) – PROP’s mission is to reduce opioid-related morbidity and mortality by promoting cautious and responsible prescribing practices. This site provides information about opioid risks and benefits for providers and consumers.
- Overdose Prevention kit – SAMHSA – This site provides information to prescribers, first responders, and family members about preventing overdose and the role of naloxone.
- Opioid risk evaluation tool – The Opioid Risk Tool (ORT) is a self-report screening tool that can be administered and scored in less than one minute, designed for use in primary care settings to assess risk for opioid abuse among adult patients prescribed opioids for treatment of chronic pain.
- MED Calculator – This site is connected to an online tool to calculate Morphine Equivalent dose of all opioids to support MED limits in guidelines. This calculator should NOT be used to determine doses when converting a patient from one opioid to another.
- Mass Medical Society – Offers information for physicians/prescribers as well as patients and families, including information on opioid overdose and naloxone, preventing prescription drug misuse, and safe storage and disposal information of opioids.
- CDC Website – The CDC’s 2022 Clinical Practice Guideline for Prescribing Opioids for Pan offers recommendations for clinicians providing pain care, including the appropriate prescribing of opioid pain relievers and other treatment options to improve pain management and patient safety.
Our mail service program offers a quick, easy way for members to get their maintenance medications. The program, which is administered by OptumRx Home Delivery, includes:
- Delivery of an 84-to 90-day supply of medications to your patient’s home
- Easy ordering — e-prescribe or order by phone (855-258-1561) or by mail using the OPTUMRx New Prescription mail-in order form
- Free standard shipping on all prescription orders
- Potential copay savings
Be sure to prescribe an 84-90-day supply, plus refills when appropriate.