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GLO-PRV-Authorization-Clear Coverage-Expiration Date Notice
Please Note: Clear CoverageTM now enables you to select an expiration date when entering preauthorization requests for physical therapy services.
Effective immediately through the end of 2019, please enter December 31, 2019 as the end date unless a shorter time frame is warranted.
Beginning January 1, 2020, please select an end date of December 31, 2020 unless a shorter time frame is warranted.
Effective immediately through the end of 2019, please enter December 31, 2019 as the end date unless a shorter time frame is warranted.
Beginning January 1, 2020, please select an end date of December 31, 2020 unless a shorter time frame is warranted.
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Prescription Drugs
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Prescription Drugs Authorization Page Content
In order to help assure our members have access to safe, effective drug therapy and to protect against inappropriate use and waste, we require prior authorization and step therapy* on selected prescription medications.
Prior Authorization & Step Therapy Requirements
- Commercial 3-Tier Prior Authorization and Step Therapy Medication ListOpen a PDF
- Child Health Plus Prior Authorization and Step Therapy Medication ListOpen a PDF
- Medicaid Managed Care Prior Authorization and Step Therapy Medication ListOpen a PDF
- Specialty Rx Medication List (Self-Administered Drugs)Open a PDF
- Provider-Administered Medical Specialty Drugs Requiring Preauthorization - Commercial, Essential Plan, Exchange and Medicare Managed CareOpen a PDF
- Provider-Administered Medical Specialty Drugs Requiring Preauthorization - Medicaid Managed Care and Child Health PlusOpen a PDF
Request Approval Online with Electronic Prior Auth (ePA)
You and your staff can request a coverage determination electronically, directly from your electronic medical record (EMR) or through CoverMyMeds ePA Portal.
With ePA:
- You can submit requests for PA prospectively
- You can renew Prior Authorizations 60 days prior to expiration
- ePA through CoverMyMeds is free
- Any authorized personnel can use ePA
Request Approval by Fax or Eform
Prior Authorization Fax Request Forms
Send Coverage Determination Request via Secure Eform
* Step Therapy - In some cases, we require members to first try certain drugs to treat their medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat the medical condition, we may not cover Drug B unless the patient tries Drug A first. If Drug A does not work for the patient, we will then cover Drug B.
