Prior Authorization Drug List and Forms
Here's a complete list of the Prior Authorization (PA) drug categories, drugs and forms for Pay-Direct-Drug (PDD) plan sponsors who participate in the PA program. Please note: drugs are listed by brand name but the program also applies to the generic form of the drug (lowest cost equivalent).
* Categories marked with an asterisk (*) are part of our previous PA program and are not applicable under Sun Life's enhanced prior authorization program.
For prior authorization details specific to your plan, please click here. You will need to input your group contract number.
If you're interested in finding out more about our Drug Intervention Programs, or if you're already participating in this program and have questions, please contact your Sun Life Financial Group Benefits representative.
View, download or print any of the PA forms below - just click on the form(s) you need. The forms are in Adobe Acrobat PDF format. If you don't already have Adobe Acrobat Reader, you can download it here:
| Drug Category | Drugs | Prior Authorization Form |
|---|---|---|
| Anti-depressant * | Wellbutrin (bupropion) |  |
| Anti-inflammatory * | Celebrex (celecoxib) | |
| Anti-obesity * | Ionamin (phentermine) Sanorex (mazindol) Tenuate (diethylpropion) Xenical (orlistat) | |
| Asthma | Xolair (omalizumab) | |
| Benign prostate enlargement * | Avodart (dutasteride) Proscar (finasteride) | |
| Biologic response modifier (for conditions such as, but not limited to, rheumatoid arthritis, Crohn's disease, plaque psoriasis) | Actemra (tocilizumab) | |
| Biologic response modifier (for conditions such as, but not limited to, rheumatoid arthritis, Crohn's disease, plaque psoriasis) | Amevive (alefacept) | |
| Biologic response modifier (for conditions such as, but not limited to, rheumatoid arthritis, Crohn's disease, plaque psoriasis) | Cimzia (certolizumab pegol) | |
| Biologic response modifier (for conditions such as, but not limited to, rheumatoid arthritis, Crohn's disease, plaque psoriasis) | Enbrel (etanercept) | |
| Biologic response modifier (for conditions such as, but not limited to, rheumatoid arthritis, Crohn's disease, plaque psoriasis) | Humira (adalimumab) | |
| Biologic response modifier (for conditions such as, but not limited to, rheumatoid arthritis, Crohn's disease, plaque psoriasis) | Kineret (anakinra) | |
| Biologic response modifier (for conditions such as, but not limited to, rheumatoid arthritis, Crohn's disease, plaque psoriasis) | Orencia (abatacept) | |
| Biologic response modifier (for conditions such as, but not limited to, rheumatoid arthritis, Crohn's disease, plaque psoriasis) | Remicade (infliximab) | |
| Biologic response modifier (for conditions such as, but not limited to, rheumatoid arthritis, Crohn's disease, plaque psoriasis) | Rituxan (rituximab) | |
| Biologic response modifier (for conditions such as, but not limited to, rheumatoid arthritis, Crohn's disease, plaque psoriasis) | Simponi (golimumab) | |
| Biologic response modifier (for conditions such as, but not limited to, rheumatoid arthritis, Crohn's disease, plaque psoriasis) | Stelara (ustekinumab) | |
| Cancer | Afinitor (everolimus) | |
| Cancer | Caprelsa (vandetanib) | |
| Cancer | Gleevec (imatinib mesylate) | |
| Cancer | Inlyta (axitinib) | |
| Cancer | Iressa (gefitinib) | |
| Cancer | Jakavi (ruxolitinib) | |
| Cancer | Nexavar (sorafenib) | |
| Cancer | Revlimid (lenalidomide) | |
| Cancer | Sprycel (dasatinib) | |
| Cancer | Sutent (sunitinib) | |
| Cancer | Tasigna (nilotinib) | |
| Cancer | Temodal (temozolomide) | |
| Cancer | Thalomid (thalidomide) | |
| Cancer | Tykerb (lapatinib) | |
| Cancer | Tarceva (erlotinib) | |
| Cancer | Votrient (pazopanib) | |
| Cancer | Xalkori (crizotinib) | |
| Cancer | Zelboraf (vemurafenib) | |
| Cancer | Zolinza (vorinostat) | |
| Cancer | Zytiga (abiraterone) | |
| Erectile dysfunction * | Cialis (tadalafil) Levitra (vardenafil) Staxyn (vardenafil) Viagra (sildenafil) | |
| Erectile dysfunction * | Cialis (tadalafil) Once-a-Day | |
| Migraine headache * | Amerge (naratriptan) Axert (almotriptan) Frova (frovatriptan) Imitrex (sumatriptan) Maxalt (rizatriptan) Relpax (eletriptan) Zomig (zolmitriptan) | |
| Migraine headache * | Botox (onabotulinumtoxinA) | |
| Multiple sclerosis | Gilenya (fingolimod) | |
| Multiple sclerosis | Tysabri (natalizumab) | |
| Osteoporosis | Forteo (teriparatide) | |
| Pulmonary arterial hypertension | Adcirca (tadalafil) Revatio (sildenafil) | |
| Rare diseases | Esbriet (pirfenidone) | |
| Rare diseases | Kalydeco (ivacaftor) | |
| Rare diseases | Kuvan (sapropterin) | |
| Rare diseases | Revolade (eltrombopag) | |
| Rare diseases | Zavesca (miglustat) | |
| Selected muscle or nerve disorders | Botox (onabotulinumtoxinA) | |
| Selected muscle or nerve disorders | Xeomin (incobotulinumtoxinA) | |
| Systemic lupus erythematosus (SLE) | Benlysta (belimumab) | |
| Ulcer/heartburn * | Dexilant (dexlansoprazole) Nexium (esomeprazole) Tecta (pantoprazole magnesium) | |
