SummaCare's Prescription Drug Benefit incorporates utilization management programs that apply restrictions on certain drugs. Utilization management restrictions include, but are not limited to, prior authorization, step therapy and quantity limits. Select the link below to view details about these programs/restrictions.
Summacare also requires prior authorization on certain drugs that are covered under the medical benefit. This would include certain drugs that are typically administered in an office, home, or outpatient setting. To view a list of the drugs requiring prior authorization under the medical benefit, click here.
To view Pharmacy Management information for SummaCare's Medicare Advantage plans, please click here.