Prior authorization information

Medications obtained through the medical benefit

Most medications covered on the medical benefit require prior authorization through Prime Therapeutics. Click here for a list of the medications authorized by Prime Therapeutics.*

Helpful information

• For new-to-market, request authorization through Prime Therapeutics. Reference the new-to-market drug policy below for more information.
• For providers outside of the MGB ACO network, Prime Therapeutics will review the medical necessity of the medication. Authorization for the member to go outside of the network must be submitted separately to the plan.

*Please note: This list is not inclusive of all medications that require prior authorization by Mass General Brigham Health Plan. This list is specific to medical specialty medications that require authorization through Prime Therapeutics only.