Learn how to use our new CareAdvance tool with training materials located on our website under Resources > Staff Training > Presentations & Guidebooks. For additional information view FAQ's Open a PDF. If you have any questions, please contact your Provider Relations Representative.
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
