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Injectible Medications - Altius 


For most plans, Injectible medications follow your medical benefit rather than a pharmacy copay. Listed are the Injectible medications that follow the pharmacy benefit:

  • Insulin
  • Glucagon
  • Imitrex
  • Bee Sting Kits (Epi-Pen, Jr.)
  • Lovenox

All other covered Injectible are reimbursed at 70% to 90% (based on your plan design) when purchased at a retail pharmacy. Your payment will apply toward the out-of-pocket maximum.

If your Injectible benefit does follow a pharmacy copay schedule, you will pay the third tier copay level. You may refer to your medical benefits brochure for your actual benefit.


Prior Authorization on Injectible medications

Most Injectible obtained from a retail pharmacy do not require prior authorization. Altius has identified Injectible medications that need prior authorization before they can be dispensed. These drugs were chosen due to their high potential for adverse reactions, contraindications, and non-compliance. You or your physician may contact Altiusí Prior Authorization Department at (801)
323-6440 or 1-800-879-0234 for an authorization form. Your provider must complete the authorization form and submit it back to the Prior Authorization Department for an authorization review. Approval or denial will be communicated to your provider. You may also phone the Prior Authorization Department for a status of your request. Examples of medications that require prior authorization are listed below:

  • Alfernon-N
  • Botulism Toxin
  • Copaxone
  • Enbrel / Kineret / Humira
  • Forteo
  • Growth Hormone - Adult
  • Growth Hormone - Children
  • Hepsera
  • Herceptin
  • Immune Globulin
  • Infergen

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