Drug Review Request

Under certain circumstances, a physician may wish to precertify a drug. Among these circumstances are:

• The drug requires precertification prior to dispensing under HMSA’s benefit policy for the drug (e.g., Xolair).
• The drug has frequency quantity limitations under HMSA’s benefit policies (e.g., abortive migraine agents).
• The drug is a non-preferred drug under HMSA’s Select drug plan, and it is being prescribed because the patient is unable to tolerate a generic or Preferred drug in the same therapeutic class, or the the patient has not responded to such generic or Preferred drug.

To precertify a drug in these circumstances, please print out the Drug Review Request Form [PDF], complete it, and fax or mail it to the fax number/address listed at the top of the form.

Revision History