BCBSFL Prior Authorization Web Form
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Biologic Immunomodulators Initial
Biologic Immunomodulators Renewal
CGRP Inhibitors (Aimovig, Emgality, Ajovy) Initial
CGRP Inhibitors (Aimovig, Emgality, Ajovy) Renewal
Constipation Agents (Amitiza, Linzess, Trulance)
Glucagon-like peptide agonists (GLP-1) (Adlyxin, Bydureon, Byetta, Ozempic, Tanzeum, Trulicity, Victoza)
Opioids (Extended Release)
Opioids (Immediate Release)
PCSK9 Inhibitors (Repatha, Praluent) Initial Authorization for Homozygous Familial Hypercholesterolemia (HoFH)
PCSK9 Inhibitors (Repatha, Praluent) Initial Authorization for Heterozygous Familial Hypercholesterolemia (HeFH), or Primary Hyperlipidemia
PCSK9 Inhibitors (Repatha, Praluent) Initial Authorization for Clinical Atherosclerotic Cardiovascular Disease (ASCVD)
PCSK9 Inhibitors (Repatha, Praluent) Renewal Authorization
Stimulants [Provigil (modafinil), Nuvigil (armodafinil)]
Topical products for atopic dermatitis [Protopic (tacrolimus), Elidel (pimecrolimus), Eucrisa]
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Other - Not Listed