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Prior Authorization & Limits

Members & Providers

Medications with Special Requirements

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 Coverage Policies

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