Prior Authorization

Certain medications require prior-authorization before coverage is approved, to assure medical necessity, clinical appropriateness and/ or cost effectiveness. Coverage of these drugs is subject to specific criteria approved by physicians and pharmacists on the Johns Hopkins HealthCare Pharmacy and Therapeutics Committee. Established criteria are based on medical literature, physician expert opinion, and FDA approved labeling information. This list is subject to change without notice and is not applicable to all EHP groups. Consult your SPD to determine if your plan is subject to this list.

How does Prior-Authorization work?
Your physician may request Prior-Authorization by completing the Prior Authorization Form and faxing it to the number listed on the top of the form. You can download a copy of this form and take it to your physician for completion.

Prior-Authorization requests are generally processed within two business days of receipt of a completed Prior-Authorization form. EHP will notify your physician of request approval or denial by fax and to you by mail.

The following list of Drugs require a Prior Authorization (PA).