Prior Authorization & Limits

Some medications have special requirements (Quantity Limits, Prior Authorization, and Step Therapy) that must be met before U of U Health Plans will cover them. Your doctor must complete this process before you can fill a prescription.

Prior Authorization is needed for certain drugs listed on the preferred drug list. In addition, all Specialty Medications (Tier 4) require prior authorization.

• Step Therapy is a type of prior authorization for medications that requires your provider first to prescribe and you to try alternative options that are generally more cost-effective and that have proven effective for your condition before you can move up a “step” to a more expensive medication.
• Quantity Limits is a set maximum of a quantity a medication that a person may have covered under the plan within a certain period of time for safety and cost reasons.

To submit a Prior Authorization or an Exception Request, your provider can either print and fax the forms for review or submit the request online.

• Pharmacy Prior Authorization or Exception Request (print and fax)
• Submit Prior Authorization or Exception Request (online)

Pharmacy Coverage Policies

To view specific University of Utah Health Plan pharmacy policies, visit the Pharmacy Coverage Policy section of the website.