Superior Select Health Plans

A Partnership for Care

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2018 Plan Year

Authorizations by Service Level

Authorization Request Form

2017 Plan Year

2017 Authorization Request Form

2017 Prior Authorization for Pharmacy (Last Updated September 01, 2017)

Many medications offered through Superior Select Health Plans require prior authorization to ensure for appropriateness and medical necessity. The link above will show the various categories of drugs requiring prior approval

2017 Step Therapy (Last Updated September 01, 2017)

Some medications require other medications to be used prior to another prescription. The link above indicated applicable medications.

2017 Quantity Limit Therapy (Last Updated September 01, 2017)

Prior Authorizations by Service Level

Last Updated: Jan 3, 2018 @ 3:30 pm

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