To  provide access to quality and clinically effective medications, IEHP uses a drug formulary. The IEHP Formulary provides information regarding medications covered under the benefit plans. 

Please note that coverage is not limited only to drugs  on the IEHP Formulary.  Many drugs not listed on the  Formulary  are covered through the Prior Authorization Process.

  Prior authorization encourages the appropriate and rational use of medications by allowing coverage only when certain conditions are met.

  The prior authorization program is based upon current medical findings, FDA-approved manufacturer labeling information, and recommendation by the IEHP Pharmacy and Therapeutics Subcommittee.

  If the medication you prescibe  is not on IEHP Formulary, you or the pharmacist may request authorization for the medication by submitting a Pharmacy Exception Request (PER)  to IEHP. If the request is approved, you will be notified and the medication will  be covered. If the request is denied, you and your patient will be notified of the decision.

Any medication not on the IEHP Formulary requires prior authorization to be covered by IEHP.

The medications requiring prior authorization are subject to change.

First line Formulary medications should be used instead of the Non-Formulary medications.  Drugs with specific criteria / guidelines are listed here:

PA Drug Criteria Summary Table - Click Here

To View Drug Criteria Referenced in Summary Table - Click Links Below:

Clinical Practice Guidelines- CPGs

Aranesp (darbepoetin) 
Epogen (epoetin) 
Genotropin (somatropin) 
Humatrope (somatropin) 
Hyalgan  (sodium hyaluronate)  
Immune Globulins (IVIG)
Lamisil(terbinafine) 
Lucentis (ranibizumab) 
Lupron (leuprolide)  
Norditropin (somatropin) 
Nutritional Supplement Adult 
Nutritional Supplement Infant Formula 
Nutropin(somatropin)
Orthovisc (sodium hyaluronate)
Procrit (epoetin)
Sporanox (itraconazole)
Supartz (sodium hyaluronate)
Synagis Form 2009-2010 
Xolair (omalizumab)