Prescriptions that meet any of the following conditions must be prior-authorized:
•A prescription for a non-preferred drug.
•A prescription for a preferred drug for a certain therapeutic class of drugs.
•A prescription for a drug when the prescribed quantity exceeds the quantity limit.
•A prescription for a multisource brand name drug that has an A-rated generic equivalent available for substitution.
If the Point-Of-Sale On-Line Claims Adjudication System indicates that a prior authorization is required and the prescription or the refill has not been prior authorized, the pharmacist notifies the patient and the prescriber that the prescription now requires prior authorization.