Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:
Prior Authorization: Champion Health Plan requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from Champion Health Plan before you fill your prescriptions. If you don’t get approval, Champion Health Plan may not cover the drug. Learn more about our Part D Prescribed Drugs: Prior-Authorization, Coverage Determination, and Exceptions.
Quantity Limits: For certain drugs, Champion Health Plan limits the amount of the drug that the Plan will cover. For example, Champion Health Plan provides 18 tablets per prescription for sumatriptan succinate oral.
Step Therapy: In some cases, Champion Health Plan requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Champion Health Plan may not cover Drug B unless you try Drug A first to see if it will be effective for you. If Drug A does not work for you, Champion Health Plan will then cover Drug B. You can find out if your drug has any additional requirements or limits by looking in the formulary. More information about the restrictions applied to specific covered drugs, prior authorizations, and step therapy restrictions is available on the Covered Medications section of our website or refer to your Evidence of Coverage. You can ask Champion Health Plan to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat your health condition.
