Prior Authorizations
Electronic Prior Authorization Submissions
Submit your prior authorization (PA) requests electronically through our preferred solution CoverMyMeds.
Electronic prior authorization (ePA) automates the PA process making it a quick and simple way to complete PA requests. The ePA process is HIPAA compliant and enables faster determinations.
For select drugs and plans, CoverMyMeds may issue immediate approval of your request and update your patient PA record to allow immediate claim adjudication.
Prior Authorization Review
Depending on the type of medication and whether any additional information is needed to process the PA request, the review process can take one day, a few days, or longer. Your assigned PA contact will guide you through the process if additional information is required. Please contact the Member Services Center at the number listed on this web page if you have questions about the PA review.
Requesting an Appeal
If a PA request is denied, instructions for the Appeals process will be included within the communication sent informing you of the decision. Additional contact information will also be provided within the communication. Please contact the Member Services Center at the number listed on this web page if you have questions about an appeal.
Requesting an Exception
To request a prescription drug prior authorization or step therapy exception, download and fill out the below request form.
Contact Our Member Services Center
Toll Free: (800) 460-8988
TTY: (866) 492-9674