This is a reminder that Express Scripts (ESI) is now performing most drug utilization management services for ConnectiCare commercial plan members, including those with plans sold through Access Health CT. This means you must submit requests for preauthorization, quantity limits and step therapy for commercial members to ESI.
This does not apply to Medicare pharmacy utilization management requests or adult chemotherapy and supportive agents. Please follow the usual process for chemotherapy and supportive agents as well as Medicare requests.
Electronic prior authorizations
We know you want to focus on your patients, not administrative tasks. That’s why we made this change and why we encourage you to take advantage of ESI’s Electronic Prior Authorization (ePA) option.
ePA is fast, secure, and simple. It’s the fastest way to get your authorizations approved. You can send 11 requests in the time it takes to fax just one. Any authorized personnel, including nurses and office staff, can use your electronic health record (EHR) or sign in to an online portal. You save time, and patients get their medications faster.
How to submit preauthorization requests with ePA:
- Check with your EHR vendor to ensure you have the latest software version enabling ePA. If not, create a free account online for the tool that works best for your office: CoverMyMeds, Surescripts, or ExpressPAth®
- Once enabled, you will see drugs requiring preauthorization while prescribing.
- When the prescription is submitted, ESI will confirm the need for preauthorization and electronically send clinical questions.
- You can answer the questions or place the request in a queue for office staff to complete later.
- Once complete, ESI will process the request and quickly respond with approval or denial.Use these phone and fax numbers for preauthorization requests for commercial members.
- Pharmacy drug reviews: call 1-877-417-5383, 24/7/365 or fax to 1-877-251-5896
- Medical drug reviews: call 1-877-391-7821, 8 a.m. to 7 p.m., Monday through Friday or fax to 1-888-631-8817
Medicare Advantage contact information
There is no change in phone or fax numbers for Medicare Advantage preauthorization requests. ConnectiCare will continue utilization management review for Medicare Advantage members. Continue sending preauthorization requests for Medicare Advantage members by phone or fax to:
- Specialty drugs: call 1-888-447-0295, 8 a.m. to 6 p.m., Monday to Friday or fax to 1-877-243-4812
- Pharmacy drugs: call 1-877-224-8168, 8 a.m. to 6 p.m., Monday to Friday or fax to 1-877-300-969
As a reminder, New Century Health (NCH) will need to preauthorize all oncology-related chemotherapeutic drugs and supportive agents when they’re given to commercial and Medicare Advantage patients in the physician’s office, outpatient hospital or ambulatory setting.
Please see the preauthorization overview chart for a summary of these requirements.