OTHER LIMITS ON ACCESS TO MEDICATIONS 

Can PDPs require that prior authorization be obtained before certain medications are prescribed?

Yes, PDPs may require that a doctor wishing to prescribe certain drugs receives permission from the plan before prescribing the medication.  This is commonly referred to as prior authorization. 

Can PDPs use step-therapy and fail first requirements?

Yes, PDPs may require that some drugs be tried first before a beneficiary can be prescribed more expensive medication.  This is commonly referred to as step-therapy. 

 Can PDPs use other cost control methods to limit access to medications?

Yes, PDPs may place limits on the use of off-label medications. You mmust carefully check your plan to see what limitations it contains.