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Blue Choice

Oral Drug Step/Prior Authorization (PA) Forms

Please note: The forms on this page do not apply to our Affordable Care Act (ACA) plans. For ACA members, please call 855-582-2022 for more information.

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

A

Abilify

Abstral

Aciphex-PA

Aciphex-ST

Acticlate

Actiq

Adoxa

Advicor

Aloxi

Alsuma

Altoprev

Ambien

Ambien CR

Amerge

Amitiza

Amrix

Anadrol 50

Android

Androgel

Antara

Anzemet

Apidra

Atacand

Atacand HCT

Atralin

Avalide

Avapro

Avita

Axert

B (Return to Top)

Basaglar

Beconase AQ

Belsomra

Butorphanol tartrate nasal spray

Bunavail

Byetta

C (Return to Top)

Celebrex-PA

Celebrex-ST

Clarinex

Clarinex D

Clozaril

Compounds

Cozaar

Crestor

Cymbalta  

D (Return to Top)

Delatestryl

Depo-testosterone

Desvenlafaxine ER

Detrol

Detrol LA

Dexilant-PA

Dexilant-ST

Diabetic Test Strips

Differin

Diovan

Diovan HCT

Ditropan XL

Doryx

Duexis

Dulera

Duragesic

Dymista

E (Return to Top)

Edarbi

Edarbyclor

Edular

Emend

Epanova 

Evekeo

Exalgo

F (Return to Top)

Fanapt 

Fazaclo

Fenoglide

Fentora

Fibricor

Flonase

Fortamet

Frova 

G (Return to Top)

Geodon

Glumetza

Gralise

Granisetron

H (Return to Top)

Humalog

Humulin

Hyzaar

I (Return to Top)

Imitrex

Incruse Ellipta

Intermezzo

Invega

Invokana

Invokamet 

Irenka

J (Return to Top)

Jentadueto

K (Return to Top)

Kazano

Khedezla

Kytril

L (Return to Top)

Latuda

Lazanda

Lescol

Lescol XL

Levemir 

Lidoderm

Lipitor

Lipofen  

Liptruzet

Livalo

Lofibra

Lotronex

Lovaza

Lumigan

Lunesta

M (Return to Top)

Maxalt

Maxalt MLT

Methitest

Mevacor

Micardis

Micardis HCT

Monodox

Myrbetriq

N (Return to Top)

Naprelan

Nasacort AQ

Natesto

Nesina

Nexium

Nuvigil

O (Return to Top)

Oleptro

Olux-E

Omnaris

Onmel

Omtryg

Ondansetron Inj

Onsolis

Opana ER 

Oseni

Oxandrin

Oxycontin

Oxytrol

P (Return to Top)

Pennsaid

Pradaxa

Pravachol

Prevacid-PA

Prevacid-ST

Prilosec-PA

Prilosec-ST

Pristiq

Proscar

Protonix-PA

Protonix-ST

Provigil

Q (Return to Top)

Qnasl

Qualaquin

R (Return to Top)

Rayos

Relpax

Retin-A

Retin-A Micro

Rhinocort Aqua

Riomet

Risperdal

S (Return to Top)

Sanctura

Sanctura XR

Sancuso

Saphris

Savaysa

Seroquel

Seebri Neohaler

Silenor

Solodyn

Sonata

Soriatane

Sporanox capsules

Sporanox oral solution 

Sprix

Subsys

Suboxone

Subutex

Sumavel DosePro  

Sustol

T (Return to Top)

Tanzeum

Tazorac

Tekturna

Tekturna HCT

Testim

Testopel

Testred

Teveten

Teveten HCT

Tobacco Cessation

Topical-Buccal-Testosterone

Toviaz

Tradjenta

Tresiba

Tretin-X

Treximet

Tricor

TriGlide  

Trilipix

Trulicity  

Toujeo

Tudorza Pressair

U (Return to Top)

Uloric 

V (Return to Top)

Vascepa

Veltin

Veramyst

Versacloz

Vimovo

Vogelxo

Vytorin

X (Return to Top)

Xyzal

Z (Return to Top)

Zecuity

Zegerid-PA

Zegerid-ST

Zetonna

Ziana

Zipsor

Zocor-PA

Zocor-ST

Zofran

Zohydro ER - PA

Zohydro ER - QL

Zolpimist

Zomig

Zomig ZMT

Zorvolex

Zubsolv

Zuplenz

Zyprexa