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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

Actiq

Aloxi

Alsuma

Altoprev

Ambien/Ambien CR

Amerge

Amitiza

Amrix

Anadrol-50

Androgel

Android

Antara

Anzemet

Apidra

Aristada

Avalide

Avapro

Avinza

Avita

Axert

Axiron

B (Return to Top)

Basaglar

Beconase AQ

Belsomra

Butorphanol tartrate nasal spray

Byetta

C (Return to Top)

Celebrex PA | ST

Clozaril

Compounds

Cozaar

Crestor  

D (Return to Top)

Delatestryl

Depo-testosterone

Desvenlafaxine ER

Detrol/Detrol LA

Diabetic Test Strips

Differin

Diovan/Diovan HCT

Ditropan XL

Dulera

Dymista

E (Return to Top)

Edarbi

Edarbyclor

Edular

Embeda

Emend

Epanova

Epiduo/Epiduo Forte

Evekeo

F (Return to Top)

Fabior

Fanapt 

Fazaclo

Fentora

Fetzima

Fibricor

Flector

Flonase

Fortesto

Frova 

G (Return to Top)

Geodon

Gralise

H (Return to Top)

Humalog

Humulin

Hyzaar

I (Return to Top)

Imitrex

Incruse Ellipta

Intermezzo

Invega

Invokamet/Invokamet XR

Invokana

J (Return to Top)

Jentadueto/Jentadueto XR

K (Return to Top)

Kadian

Kazano

Khedezla

Kytril

L (Return to Top)

Latuda

Lazanda

Lescol/Lescol XL

Levemir 

Lidocaine

Lipitor

Lipofen  

Livalo

Lofibra

Lovaza

Lumigan

M (Return to Top)

Maxalt/Maxalt MLT

Mevacor

Micardis/Micardis HCT

MS Contin

Myrbetriq

N (Return to Top)

Naprelan

Nasacort

Natesto

Nesina

O (Return to Top)

Oleptro

Olux-E

Omtryg

Onsolis

Opioid Management - Combination Products

Opioid Management - Extended Release Products

Opioid Management - Immediate Release Products

Oramorph

Oseni

Oxandrin

Oxytrol

P (Return to Top)

Pradaxa

Pravachol

Q (Return to Top)

Qnasl

R (Return to Top)

Rayos

Relpax

Rexulti

Riomet

Risperdal

S (Return to Top)

Sanctura/Sanctura XR

Sancuso

Saphris

Savaysa

Seebri Neohaler

Silenor

Sonata

Soriatane

Sporanox capsules & oral solution 

Sprix

Subsys

Sumavel DosePro  

Sustol

T (Return to Top)

Tanzeum

Tazorac

Tekturna/Tekturna HCT

Testim

Teveten/Teveten HCT

Tobacco Cessation

Toviaz

Tradjenta

Tresiba

Tretin-X

Treximet

Tricor

TriGlide  

Trilipix

Trulicity  

Tudorza Pressair

U (Return to Top)

Uloric 

V (Return to Top)

Vascepa

Veltin

Versacloz

Vogelxo

Z (Return to Top)

Zetonna

Zipsor

Zocor

Zofran

Zolpimist

Zomig/Zomig ZMT

Zorvolex

Zuplenz

Zyprexa