To find out whether a drug requires prior authorization, please refer to the Senior Preferred Part D formulary or review the printable 2012 Prior Authorization Drug List.

Senior Preferred requires you or your physician to get prior authorization for certain drugs. A team of doctors and pharmacists developed the prior authorization requirements for Gundersen Lutheran Health Plan to help us provide quality coverage to our members. Drug prior authorizations ensure that our members use these drugs in the most effective way which also help us to control drug plan costs.

If you take a drug that is subject to prior authorization, you will need to work with your physician to complete and submit an exception request for review by the Senior Preferred Pharmacy Department. This means you will need to get approval from Senior Preferred before you fill your prescriptions. If you don’t get approval, Senior Preferred may not cover the drug.

In order to request an exception (such as coverage of a drug that is not included on the formulary list or to request a drug be covered at a lower copay) please fill out the Medicare Prescription Drug Coverage Determination form. The form can be faxed to (608) 775-8790 or mailed to:

Attention: Pharmacy Department
Gundersen Lutheran Health Plan
1836 South Avenue, Mail Stop: NCA2-01
La Crosse, WI 54601

If you have questions, please contact the Gundersen Lutheran Health Plan Pharmacy Department.

This webpage was last updated on January 3, 2012.