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Clinical Prior Authorization

The following clinical prior authorizations have been implemented for Medicaid members, consistent with the Vendor Drug Program:

The following clinical prior authorizations have not been implemented for Medicaid members at this time. Once implemented, a link to the clinical edit criteria will be provided.

  • Alprazolam/Carisoprodol/Hydrocodone
  • Altabax
  • Carisoprodol Overuse
  • Cox-2 Inhibitors
  • Drug Regimen Optimization
  • Duplicate Therapy
  • Ketorolac (Toradol)
  • Opiate Overutilization 
  • Oxycontin (Narcotic Analgesic) 
  • Plavix 

Ambetter from Superior HealthPlan


Current Preferred Drug List


Learn more about Medicare prescription drug coverage here.