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Pre-authorization

Some drugs require pre-authorization because of potential for misuse, adverse reactions, safety issues, and cost. Please refer to the list below to see if your medication requires pre-authorization.

You may call 801-366-7555 or 800-765-7347 to initiate a pre-authorization or to check status of a pre-authorization request. Providers may also download pre-authorization forms on PEHP for PROVIDERS. We’ll let your doctor know if the pre-authorization request has been approved or denied.

*The pre-authorization list may be subject to change.

 Drug NameAdministratorPhysician pre-authorization phone numberMember inquiry phone number
1. AbraxanePEHP Pharmacy(801) 366-7555(800) 765-7347
2. AciphexPEHP Pharmacy(801) 366-7555(800) 765-7347
3. ActemraPEHP Pharmacy(801) 366-7555(800) 765-7347
4. ActimmunePEHP Pharmacy(801) 366-7555(800) 765-7347
5. ActiqPEHP Pharmacy(801) 366-7555(800) 765-7347
6. AdagenPEHP Pharmacy(801) 366-7555(800) 765-7347
7. AdcircaPEHP Pharmacy(801) 366-7555(800) 765-7347
8. Adderall (After age 18)PEHP Pharmacy(801) 366-7555(800) 765-7347
9. Adderall XR (After age 18)PEHP Pharmacy(801) 366-7555(800) 765-7347
10. AdvatePEHP Case Management(801) 366-7555(800) 765-7347
11. AfinitorPEHP Pharmacy(801) 366-7555(800) 765-7347
12. AldurazymePEHP Pharmacy(801) 366-7555(800) 765-7347
13. Alferon-NMedco(800) 753-2851(800) 903-4725
14. AlimtaPEHP Pharmacy(801) 366-7555(800) 765-7347
15. AllegraPEHP Pharmacy(801) 366-7555(800) 765-7347
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Important!

Information on this page does not apply to Medicare Part D. Click Here for Medicare Part D benefit information.

Do you want to lower your pharmacy out-of-pocket costs?




Ask your doctor or pharmacist if your prescription is available in an equivalent generic; many are, and PDF Icon preferred generics have the lowest copayment.

A preferred generic drug must contain the same active ingredient in the same equivalent strength as the brand-name version and meet the same FDA standards.