1 | Falls into existing class/category on Preferred Drug List (PDL), subject to non-preferred PA process. |
2 | Falls into the existing Step Therapy class PA process. |
3 | Falls into both PDL and Step Therapy requirements (1 and 2). |
4 | Chemical drugs available in alternate existing dosage forms to be tried first. |
5 | 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. |
6 | 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. |