When a medication isn't on our formulary (drug list) or has a utilization management requirement, you’ll want to request pharmacy PA. Take a minute to review our current guidelines.
You can check your provider manual (PDF). Or call us at 1-866-827-2710 (TTY: 711).
You'll need the right tools and technology to help our members. That’s why we’ve partnered with CoverMyMeds® and Surescripts to provide a new way to request a pharmacy PA with our ePA program.
With ePA, you can look forward to saving time with:
Less paperwork
Fewer phone calls and faxes
Quicker determinations
Safe and secure HIPAA-compliant submitted requests
Getting started with ePA is free and easy. You’ll need this info to enroll:
BIN: 610591
GRP: rx8817
PCN: ADV 610591
You can enroll two different ways:
You can enroll with CoverMyMeds online. Or call 1-866-452-5017.
You can enroll with Surescripts online. Or call 1-866-797-3239.
If you don’t want to enroll in ePA, you can request PA:
You can request PA through our secure Provider Portal.
You can request PA by calling us at 1-866-827-2710 (TTY: 711).
Check “Request forms” below to find the right form. Then, fax it with any supporting documentation for a medical necessity review to 1-877-270-3298.
If you don’t see the right form in the list, you can use the universal pharmacy request form (PDF). Otherwise, check for the drug class or drug name that matches your needs:
Calcitonin gene-related peptide receptors (PDF)
Colony stimulating factors (PDF)
Cystic fibrosis medications (PDF)
Cytokine and cell adhesion molecule (CAM) antagonists (PDF)
Erythropoiesis stimulating agents (PDF)
Gonadotropin releasing hormone analogs (PDF)
HIV: Duplicative use, inappropriate interaction and unboosted (PDF)
Hyaluronic acid derivatives (PDF)
Hyperlipidemia medications (PDF)
Idiopathic pulmonary fibrosis (PDF)
Injectable osteoporosis agents (PDF)
Interleukin-5 antagonists (PDF)
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