Indicates whether a copay is required for a medication

Indicates whether a coinsurance is required for a medication

Additional actions are required (of the patient, the provider, or both) to receive authorization from the insurer before a medication is prescribed.

Prior Authorization steps required before a medication can be prescribed

Indicates whether a patient must try another medication before a medication may be prescribed

A description of the medication (or medications) that need to be tried before a medication is prescribed

Indicates whether there is a limit to the quantity or amount of a medication that will be covered under the health plan

Indicates whether an age limit is imposed on a medication

A description of the age limits imposed on a medication

Medications are considered 'limited access' if the FDA says the drug can be given out only by certain facilities or doctors. These medications may require extra handling, provider coordination or patient education that can’t be done at a network pharmacy

A description of how and why a medication is classified as 'limited access'

The medication is available in injectable form

The medication is available through mail order

The medication may be covered under Medicare Part B or D depending upon the circumstances. Information may need to be submitted describing the use and setting of the medication to make the determination.