Falls into existing class/category on Preferred Drug List (PDL), subject to non-preferred PA process.
Falls into the existing Step Therapy class PA process.
Falls into both PDL and Step Therapy requirements (1 and 2).
Chemical drugs available in alternate existing dosage forms to be tried first.
Product is a racemic mix, single enantiomer or diastereomer, or isomer of available medication, or prodrug metabolized to available medication or active metabolite of available medication.
If the drug does not fall into mentioned categories, the patient must have an inadequate response to two or more medications FDA-approved for the same indication and/or medications that are considered the standard of care for the indication, when such agents exist.