2018 Pharmacy Preauthorizations

These drugs are covered under the pharmacy benefit only.

Providers can initiate the preauthorization requests by faxing Avera Health Plans at 1-800-269-8561 with the appropriate form and supporting documentation.

NOTE: Not all plans cover these drugs nor require preauthorization. Please refer to the member's Individual Policy (also known as Certificate of Coverage, Master Contract or Plan Document) for information regarding coverage determination.

** This list does not guarantee coverage and is subject to change.**