2022 New Hampshire Select Drug List
Search by medication name for up-to-date drug information, including the benefit tier your drugs are on, as well as applicable clinical edits such as prior authorization or step therapy requirements.
You can also view the full drug list here. (Some pages of this document are intentionally left blank.)
Your coverage has limitations and exclusions, which means that some drugs on this list may not be covered, depending on your plan’s design. To find out more, please refer to yourCertificate/Evidence of Coverageor yourSummary Plan Description
To our providers: Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients
get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts®
Log in to CoverMyMeds®
This drug search tool will be updated at least quarterly.