Step Therapy Programs - DAKOTACARE - Sioux Falls, SD

Step Therapy Programs

Providers can initiate preauthorization by submitting a request online at www.dkc-pa.com.

NOTE

Not all plans cover these drugs or require preauthorization. Refer to the member’s policy (also known as the Master Contract, Certificate of Coverage or Plan Document) to determine coverage.

***This list does not guarantee coverage and is subject to change.***

STEP ONE STEP TWO
Albuterol Inhalers
  • albuterol HFA
  • levalbuterol HFA
  • ProAir Digihaler
  • ProAir HFA
  • ProAir Respiclick
  • Ventolin HFA
  • Proventil HFA
Antidepressants-SNRI
  • buproprion
  • citalopram
  • desvenlafaxine ER (generic)
  • duloxetine
  • escitalopram
  • fluoxetine
  • fluvoxamine
  • paroxetine
  • sertraline
  • venlafaxine
  • Desvenlafaxine ER (brand)
Antifungal Agents-topical
  • ciclodan/ciclopirox
  • clotrimazole
  • econazole
  • ketoconazole
  • miconazole
  • naftifine
  • nystatin
  • oxiconazole
  • Ecoza
  • Ertaczo
  • Exelderm
  • Jublia
  • Naftin
  • Oxistat
  • Xolegel
Biliary Cirrhosis Agents
  • ursodiol
  • Ocaliva
Fibromyalgia
  • duloxetine
  • gabapentin
  • Neurontin (brand)
Glaucoma
  • latanoprost
  • Lumigan (brand)
  • Travatan Z (brand)
  • Zioptan
Gout
  • allopurinol
  • febuxostat
  • Zurampic
Pain
  • buprenorphine patch
  • hydromorphone ER
  • methadone
  • morphine ER
  • oxycodone ER
  • Arymo ER
  • Butrans
  • Embeda
  • Hysingla ER
  • Kadian ER
  • Morphabond
  • Nucynta ER
  • Oxycontin
  • Xtampza ER
  • Zohydro ER