Self-administered medications

Adcirca Alprazolam ER/XR Ampyra Byetta Cimzia Crinone Effient Emend Enbrel Femara Humira Itraconazole Kineret Nuvigil Prochieve Progesterone in oil Promacta

Provigil Prozac Weekly Raptiva Ranexa Revatio Revlimid Simponi Soriatane Stavzor Stelara Terbinafine Topical tretinoin (age 26 or older) Tyvaso Xenazine Xyrem Ziana

Self-administered OR provider-administered specialty medications

Epogen/Procrit Fentanyl Increlex Leukine

Lupron Neulasta Neupogen Simponi

Provider-administered specialty medications
The WEA Trust requires your doctor to call (800) 279-4000 for approval before we pay for any provider-administered (including hospital, doctor's office, and infusion suites) specialty medications such as those listed below.
Please keep in mind that the list below is not complete but contains examples of common provider-administered specialty drugs.

Abraxane Actemra Alimta Aloxi Amevive Aranesp Avastin Boniva injection Carimune/Gammagard (powder) Cimzia Erbitux Flebogamma Gammagard (liquid)

Gamunex Growth hormones Herceptin NPlate Octagam Orencia Privigen Reclast Remicade Rituxan Synagis Vectibix Vivitrol Xolair

Dispense as written
Generic drugs save you and your health plan money. The Food and Drug Administration's clinical evidence shows that generic equivalents work just as well as brand-name drugs for patients in nearly all cases. (See the FDA's Web site on generic drugs.) A prescription written as "dispense as written" (DAW) means a pharmacist cannot substitute a generic equivalent for the brand-name drug. Your Trust health plan requires your physician to justify the medical need for a DAW brand-name prescription over its generic equivalent. Download the Dispense As Written Preauthorization Form for you and your doctor to complete. We would also like your doctor to complete the optional MedWatch Form, which helps the FDA track occurrences where a medication's quality and effectiveness might be in doubt.

Step therapy
Step therapy means you have to first try one drug to treat a condition before another drug to treat that condition is covered. Step therapy promotes safe and cost-effective drug utilization based on clinical protocols agreed to by medical experts, the makers of the drugs, and the Food and Drug Administration (FDA).

Members with a new prescription for a drug listed below must try a first-line treatment or have their doctor call (800) 294-5979 or (800) 279-4000 for approval before receiving coverage (If you're in the Three-Tier Drug Plan, remember that copayments vary even for drugs that may be approved.):

Atacand Avalide Avapro Benicar Celebrex Clarinex Cozaar Diovan Extina Flector

Hyzaar Luvox CR Lyrica Micardis Pristiq Savella Teveten Uloric Veramyst Xyzal

Dispensing limits
For certain drugs, we will reimburse to the quantity limit considered safe and effective by the FDA and the drug manufacturer for a 30-day supply. The following drugs may require preauthorization depending on the quantity dispensed:

Actiq Amerge Axert ED drugs Fentora Frova Lantus Levimir Maxalt Migranal NS

Opana Regranex Relistor Relpax Ryzolt Sancuso Sumatriptan Ultram ER Zolpidem Zomig

If your doctor believes the quantity limits do not meet your needs, he or she can call (800) 294-5979.