Specialty Drug List by Disease State Specialty Medications on This List Require Prior Authorization Please fax Specialty Medication Authorization Form and supporting medical records to Delaware Physicians Care at 1-877-861-2611
• This list applies only to medications administered in a physician’s office.
• Self-administered injectable medications and home infusion medications are available through the
BLOOD CELL DEFICIENCY OSTEOARTHRITIS RESPIRATORY GROWTH DEFICIENCY CONDITIONS MISCELLANEOUS SPECIALTY CONDITIONS ATYPICAL ANTIPSYCHOTICS INFLAMMATORY CONDITIONS
Delaware Physicians Care’s Pharmacy department wil review the request for prior authorization. If the request is approved, you wil
be notified via fax. Within three (3) business days of an approval, CVSCaremark wil mail the drug directly to your office and if it is
urgent, within forty-eight (48) hours of an approval. This means you wil no longer have to purchase the drug and bil Delaware
Physicians Care to receive reimbursement. Delaware Physicians Care wil continue to reimburse you for the administration of drugs.
Should your request for an injectable drug be denied authorization, Delaware Physicians Care wil notify you and the respective
member of the outcome according to our normal denial notification process. If you have any questions, please contact Provider
Note: This drug list is a guide to medications that are covered for administration in a physician’s office. Updated 02/17/2014 Specialty Drug List by Disease State Specialty Medications on This List Require Prior Authorization Please fax Specialty Medication Authorization Form and supporting medical records to Delaware Physicians Care at 1-877-861-2611 ANTIBIOTICS MISCELLANEOUS SPECIALTY CONDITIONS
HORMONE REPLACEMENT
Depo-Testosterone (testosterone cypionate)
Lupron Depot®/ Deot-PED® (leuprolide acetate)
ANTIFUNGALS
Vfend Delaware Physicians Care’s Pharmacy department wil review the request for prior authorization. If the request is
approved, you wil be notified via fax. Within three (3) business days of an approval, CVSCaremark wil mail the
drug directly to your office and if it is urgent, within forty-eight (48) hours of an approval. This means you wil no
longer have to purchase the drug and bil Delaware Physicians Care to receive reimbursement. Delaware Physicians
Care wil continue to reimburse you for the administration of drugs. Should your request for an injectable drug be
denied authorization, Delaware Physicians Care wil notify you and the respective member of the outcome
according to our normal denial notification process. If you have any questions, please contact Provider Relations at
Note: This drug list is a guide to medications that are covered for administration in a physician’s office. Updated 02/17/2014
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Specialty Drug List by Disease State 
Specialty Drug List by Disease State