In accordance with NYS Executive Order #4Open a PDF, we will suspend preauthorization requirements for dates of service September 27 - October 27, 2021 for scheduled hospital surgeries and admissions, hospital outpatient services, home health care services following a hospital admission and inpatient and outpatient rehabilitation services following a hospital admission for our fully insured and Medicare Advantage members. Review our communication for additional details. Please continue to notify us of all inpatient admissions and discharges to ensure continuity and coordination of care.
CareAdvance Expedited Requests: If an authorization is an expedited request, the provider must call Medical Intake with a case number to expedite.
Prescription Drugs
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, Exchange and MedicareOpen a PDF
- Provider-Administered Medical Specialty Drugs Requiring Preauthorization - Medicaid, Child Health Plus, and Essential PlanOpen 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.
